Introduction of an interactive tool (the Dental Trauma Guide) in the undergraduate dental teaching to manage traumatic dental injuries.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are complex problems where lack of proper care may result in serious complications. The need to improve the management of TDI is a frequently addressed concern. Methods of improvement in their diagnosis and management are continuously evolving. The interactive Internet tool, the Dental Trauma Guide (DTG), helps to simplify diagnostic and management dilemmas. However, it is not a freely available tool. The aim of the current study was to assess the knowledge and diagnostic skills of undergraduate dental students with access to the DTG compared with students without such access, in order to validate and promote this tool in dental education. MATERIALS AND METHODS: Two groups of students were randomly selected where one group of final year dental undergraduate students were exposed to lectures, demonstrations, discussions and tutorials on the management of TDI according to the standard undergraduate curriculum in Sri Lanka. Another test group of 21 students were provided with access to DTG during their training in paediatric dentistry. At the end of the study period, students were assessed on their knowledge of TDI using MCQs (Multiple Choice Questions) and OSCEs (Objective Structured Clinical Examination), based on the DTG. RESULTS: The students with access to the DTG were more knowledgeable in providing the correct answers to three out of the seven OSCE questions. Evaluation based on the MCQs did not reveal a significant difference (p = .913). However, users of the DTG showed a statistically significant difference with better overall knowledge based on their answers (p = .028). Following this period of evaluation, all of the students were provided with access to the DTG to supplement their learning experience. CONCLUSION: The Dental Trauma Guide is a useful supplementary tool for undergraduate students to arrive at a correct diagnosis and treatment plan for TDI.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Hebrew edition].

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented. The Hebrew Edition is part of the IADT global effort to provide accessibility to these guidelines worldwide.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Hebrew edition].

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This scond part of the guidelines will focus on avulsion of permanent teeth.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Hebrew edition].

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition.

The effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with orthodontic elastomeric separator placement.

BACKGROUND: The initial placement of orthodontic elastomeric separators can be uncomfortable and painful. Therefore, it is important to relieve this disturbing sensation to create a discomfort or pain-free orthodontic visit. The purpose of this study was to investigate the effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with the placement of orthodontic elastomeric separators. METHODS: Fifty subjects aging between 20-35 years were included in this study. In the maxillary arch, a lidocaine/prilocaine topical anesthetic was placed around the ginigval margins of the premolar and molar on side. On the other side, a placebo agent was placed around the ginigval margins of the premolar and molar. After two minutes, an elastomeric separator was placed between the premolar and molar on both sides. The subjects were then asked to report their findings on a Verbal Scale and a Visual Analogue Scale every second minute for a period of 10 min. The subjects were also given a questionnaire to evaluate the overall impression on the topical anesthetic use. RESULTS: The overall mean discomfort/pain score was found to be significantly lower (p < 0.001) with the topical anesthetic than with the placebo. Repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean pain scores were statistically significantly low with the 10-min time duration (F (1.54,42.2) = 40.7, p = 0.001), with an estimated grand mean (8.37, 95% CI 6.75-9.98). The questionnaire responses revealed that 87% of the subjects reported an overall satisfaction and agreement with the topical anesthetic than with the placebo or no difference (13%) after the initial separator placement. CONCLUSIONS: The discomfort and pain resulting from the initial placement of orthodontic elastomeric separators can be significantly reduced with the lidocaine/prilocaine topical anesthetic.

Patients' perception of improvement after orthognathic surgery: pilot study.

We aimed to find out what patients thought of their quality of life after they had had an orthognathic operation. Thirty-two patients returned three questionnaires and 15 were further interrogated by telephone. Preoperatively the patients mentioned mainly functional problems as a reason for asking for the operation, but expectation of aesthetic improvement was also an important factor. They were generally satisfied with the outcome of the operation. Postoperative improvement was mentioned in terms of chewing, appearance, headaches, and bullying. Patients felt more secure in company with other people postoperatively. We conclude that patients' perceptions after orthognathic operations were generally favourable but there is a need for improved information to patients during the treatment.

Substantial glucose leakage from liposomes on filters and upon molecular-sieve chromatography in determinations of reconstituted glucose-transport activity and liposome volumes.

Transport-protein activities are often determined by procedures that involve isolation of liposomes containing the transported radioactive solute. We determined the activity of the human red cell glucose transporter in liposomes and, by similar procedures, internal volumes of liposomes. For these purposes, we isolated freeze-thawed liposomes loaded with [14C]glucose, either by filtration on cellulose-nitrate and cellulose-acetate filters, or by chromatography on Sephadex. The interaction of liposomes with filters caused substantial leakage of [14C]glucose. About half of the internal [14C]glucose was released on the filters from glucose-transporter liposomes with inhibited transport. Chromatography at high flow rate provided higher and more accurate values than did the filtration procedure. Leakage corrections could be made by use of flow-cell scintillation elution profiles. The ratios between the corrected chromatographic volume values and the filtration values were 1.4-3.0 for liposomes without protein, 2.4-4.0 for glucose-transporter liposomes and 3.6-7.9 for liposomes with several human red cell integral membrane proteins. The D-glucose equilibrium exchange with glucose-transporter liposomes at 50 mM D-glucose was 2.0 nmol D-glucose per microgram transporter per second as determined by use of chromatography at high flow rate. The filtration procedure gave only 0.6 nmol.microgram-1.s-1 due to the [14C]glucose leakage. In our experiments, the chromatographic procedure thus proved superior.

Monoacylglycerol hydrolase in human platelets.

In the present paper we show for the first time monoacylglycerol hydrolase in human platelets. No monoacylglycerol hydrolase activity could be demonstrated in the other blood cells. The monoacylglycerol hydrolase of platelets could not be released from the cells by heparin, thus the enzyme is distinct from the postheparin plasma lipases. The enzyme could be solubilized by a non-ionic detergent, Triton X-100. The solubilized monoacylglycerol hydrolase from platelets was optimally active at pH between 7 and 8 and at ionic strength corresponding to [NaCl] between 0.1 and 0.3 M. The optimal assay temperature was 37 degrees C. The enzyme activity was sensitive to HgCl2 but not to NaF. Accordingly, it was stabilized by 2-mercaptoethanol.

Monomeric human red cell glucose transporter (Glut1) in non-ionic detergent solution and a semi-elliptical torus model for detergent binding to membrane proteins.

The self-association state of the human red cell glucose transporter (Glut1) in octaethylene glycol n-dodecyl ether (C12E8) and n-octyl beta-D-glucopyranoside (OG) solution was analyzed in the presence of reductant by gel filtration with light-scattering, refractivity and absorbance detection, and by ultracentrifugation. The C12E8-Glut1 complex was essentially monomeric, whereas OG-Glut1 also formed dimers and larger oligomers. C12E8-Glut1 retained substantial glucose transport activity even after depletion of endogenous lipids by gel filtration, as shown by reconstitution and transport measurements. Removal of endogenous lipids from OG-Glut1 abolished the activity unless phosphatidylcholine was included in the eluent. The binding of C12E8 and OG to Glut1 was determined by gel filtration with refractivity and absorbance detection or with radioactive tracer to be 1.86 +/- 0.07 and 1.84 +/- 0.09 g/g polypeptide, respectively. A structural model was proposed in which non-ionic detergent forms a semi-elliptical torus (SET) surrounding the transmembrane protein. The torus thickness was assumed to be equal to the radius (short half-axis) of a spherical (oblate ellipsoidal) free detergent micelle and the polar head groups of the detergent molecules were predicted to be situated just outside the hydrophobic surface of the protein. The experimental detergent binding values and those obtained from the SET model together confirmed that Glut1 was monomeric in C12E8 solution and provided constraints on the shape and size of the hydrophobic transmembrane region of Glut1 in alpha-helical and beta-barrel topology models.

Comparison between absorbable and nonabsorbable, monofilament sutures for end-to-end arterial anastomoses in growing pigs.

End-to-end anastomoses of the iliac arteries in growing pigs were constructed with interrupted 7-0 absorbable polydioxanone (PDS) or polypropylene (Prolene) sutures. Comparison between the two monofilament suture materials was made with respect to macroscopic and microscopic examinations, angiographic findings, recorded tensile breaking forces, and calculated blood flow values within the arterial walls at the level of the anastomoses. The angiographic examinations and the recorded tensile breaking forces did not reveal any difference between PDS- and Prolene-sutured anastomoses. On the other hand, the macroscopic findings, the histologic examination, and the calculated blood flow values (6.1 +/- 4.7 and 16.8 +/- 2.3 ml/min/100 gm for PDS- and Prolene-sutured anastomoses, respectively) point to a far more pronounced inflammatory tissue reaction with Prolene. The obtained differences clearly suggest the use of absorbable PDS instead of nonabsorbable Prolene sutures for arterial anastomoses.

Storage of experimentally avulsed teeth in milk prior to replantation.

Extracted monkey teeth were endodontically treated, stored in milk or saliva for two or six h, and then replanted. Periodontal conditions were evaluated after eight wk. Teeth that had been stored for two or six h in milk or for two h in saliva showed periodontal healing almost as good as that of immediately replanted teeth. Teeth that had been kept in saliva for six h or bench-dried for one h showed extensive replacement resorption. Milk may thus be recommended as a storage medium for ex-articulated teeth prior to replantation in cases when immediate replantation is not possible.

Pregnancy outcome among women in a Swedish rubber plant.

Suspicions of reproductive disturbances among women in a tirebuilding department was the reason for this study, encompassing 42 women, 30 of whom provided a total of 84 pregnancies out of which 21 were exposed to the tirebuilding process. Nine of the 21 exposed pregnancies had an unfavorable outcome (threatening abortion, spontaneous abortion or malformation) versus only seven of the remaining 63 nonexposed pregnancies, a difference which remained significant also when various risk indicators like age, smoking, pregnancy order, and calendar year were taken into account. In contrast to earlier observations, there was no difference in thioether excretion in the urine (as potentially indicative of the skin absorption of rubber chemicals) between women working in the tirebuilding department and a reference group. It remains unclear however whether the observed cluster was causally related to occupational exposures or not, but, together with other observations, this report may contribute to the elucidation of possible reproductive disturbances in the rubber industry.

Hemorrhage in the floor of the mouth during implant placement in the edentulous mandible: a case report.

This report describes a life-threatening hemorrhage in the floor of a patient's mouth during routine implant placement in the anterior mandible. Airway obstruction caused by hematoma development resulted in acute nasotracheal intubation and subsequent surgical intervention. Surgical, radiographic, and anatomic considerations to prevent severe bleeding are discussed. An extraoral submental approach in cases with large sublingual hematomas is recommended. An outpatient should be treated in or close to a hospital where these complications can be dealt with promptly and effectively.

Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome.

Habitual heavy snoring may be considered a preliminary stage of sleep apnea syndrome. This investigation deals with the craniofacial morphology of 51 heavily snoring patients, with and without obstructive sleep apnea, and with 28 healthy control patients. The apnea group showed a reduced posterior airway and a posterior rotation of the mandible. Reduction of the anterior-posterior diameter of the cranial base, maxilla and mandible and vertical reduction of the posterior facial height appeared to be common facial characteristics in both snoring and apnea patients. These findings indicate an anatomical disposition for snoring and apnea.

CT scan prior to installation of osseointegrated implants in the maxilla.

A method using computed tomography (CT) for evaluation of maxillary structures before installation of titanium fixtures is described. This method gives us comprehensive information of relevant bony structures and bone quality. The width of the paranasal sinuses, nasal cavity and incisal canal is properly evaluated and the method facilitates measurements of available space for position, number and length of fixtures to be installed.

Diagnosis and treatment of the unicystic ameloblastoma.

Two cases of unicystic ameloblastoma are presented. The lesions were pain-free and expanded the mandible. They were removed by curettage. Recurrent lesions had similar clinical appearances and histological pictures compared to the original lesions. The unicystic ameloblastoma manifested itself as a cystic cavity without solid neoplastic features, which differs from the solid ameloblastoma with regard to the age of the patients and the rate of recurrence. The behavior of the unicystic ameloblastoma was similar to that of the primordial cyst. Despite the obvious risk of recurrence, conservative treatment with enucleation and curettage seemed to be justified in preference to mutilating radical surgery.

Tumor necrosis factor-alpha and transforming growth factor-beta1 in chronic periapical lesions.

OBJECTIVE: Proinflammatory cytokines are involved in the pathogenesis of periapical lesions. The purpose of this study was to evaluate the presence of the cytokines tumor necrosis factor-alpha (TNF-alpha) and transforming growth factor-beta(1) (TGF-beta(1)) in periapical pathosis and to determine their relationship to the size of the lesions. STUDY DESIGN: One tooth from each of 25 patients was root-end resected, and the periapical lesion was collected. The amounts of TNF-alpha and TGF-beta(1) were assessed by enzyme-linked immunosorbent assay. RESULTS: TGF-beta(1) was detected in 21 of 25 lesions. In samples with scar tissue, no TGF-beta(1) activity was detected. A statistically significant correlation was found between TGF-beta(1) per milligram of tissue and the diameter of the lesions. TNF-alpha was detected in only 2 samples. CONCLUSIONS: TGF-beta(1) was present in periapical granulomas and cysts but not in lesions with scar tissue. The correlation between the amount of TGF-beta(1) per milligram of tissue and the size of the lesion was significant.

A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.

The enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnoea (OSA) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. Reports on the beneficial effects of dental appliances exist, but only one prospective randomized study has been published comparing dental appliances with nasal continuous positive airway pressure (CPAP) treatment. No study has been published comparing dental appliance treatment with UPPP. Ninety-five male patients with confirmed OSA, subjective daytime sleepiness and an apnoea index (AI) > 5 were randomized for subsequent treatment with either a dental appliance or UPPP. There were 49 patients in the dental appliance group and 46 in the UPPP group. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up. The success rate (rate of patients with at least a 50% reduction in AI) for the dental appliance group was 95%, which was significantly higher (p < 0.01) than the 70% success rate for the UPPP group. According to the criteria for OSA (apnoea index > or = 5 or apnoea/hypopnoea index > or = 10), 78% of the dental appliance group and 51% of the UPPP group were normalized after 12 months. The difference between the groups was significant (p < 0.05). These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA.

Reliability of breath-alcohol analysis in individuals with gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is widespread in the population among all age groups and in both sexes. The reliability of breath alcohol analysis in subjects suffering from GERD is unknown. We investigated the relationship between breath-alcohol concentration (BrAC) and blood-alcohol concentration (BAC) in 5 male and 5 female subjects all suffering from severe gastroesophageal reflux disease and scheduled for antireflux surgery. Each subject served in two experiments in random order about 1-2 weeks apart. Both times they drank the same dose of ethanol (approximately 0.3 g/kg) as either beer, white wine, or vodka mixed with orange juice before venous blood and end-expired breath samples were obtained at 5-10 min intervals for 4 h. An attempt was made to provoke gastroesophageal reflux in one of the drinking experiments by applying an abdominal compression belt. Blood-ethanol concentration was determined by headspace gas chromatography and breath-ethanol was measured with an electrochemical instrument (Alcolmeter SD-400) or a quantitative infrared analyzer (Data-Master). During the absorption of alcohol, which occurred during the first 90 min after the start of drinking, BrAC (mg/210 L) tended to be the same or higher than venous BAC (mg/dL). In the post-peak phase, the BAC always exceeded BrAC. Four of the 10 subjects definitely experienced gastric reflux during the study although this did not result in widely deviant BrAC readings compared with BAC when sampling occurred at 5-min intervals. We conclude that the risk of alcohol erupting from the stomach into the mouth owing to gastric reflux and falsely increasing the result of an evidential breath-alcohol test is highly improbable.

Interdental wiring in jaw fractures: effects on teeth and surrounding tissues after a one-year follow-up.

Several authors have suggested that interdental wiring may have an adverse effect on the teeth and surrounding tissues. In the present study we examined 250 teeth that had been subjected to wiring and 142 adjacent teeth that had not been wired (controls). During the wiring period, and after a minimum of 1 year following treatment of the jaw fracture, the teeth and periodontal tissues were examined by periodontal probing, percussion sound test, mobility test, sensitivity test, and radiography. One tooth showed temporary increased mobility. Periodontal health was clinically and radiologically fully restored after a year in all teeth. Progressive caries was seen in 2 patients and was treated. Loss of sensitivity was seen in 3 teeth adjacent to the fracture site and in one tooth adjacent to a titanium cortical screw. However, these pulpal changes either recovered spontaneously or were treated endodontically. There were few late problems in the teeth and surrounding tissues. In 243 teeth (97%), completely healthy conditions were found in pulp and periodontium. There was no evidence of root resorption or dentoalveolar ankylosis. We conclude that late deleterious effects on the teeth and periodontal tissues from interdental wiring in the treatment of jaw fractures were uncommon 1 year after the removal of the interdental wiring.