Salivary gland ultrasonography: can it be an alternative to sialography as an imaging modality for Sjogren's syndrome?

OBJECTIVES: Salivary ultrasonography (US) was evaluated as an alternative imaging modality to sialography for Sjögren's syndrome (SS). METHODS: Parotid sialography and parotid and submandibular US were performed in 360 patients (188 with SS and 172 non-SS) who were suspected of SS and had fulfilled the American-European criteria (AEC) for SS or had received > or =3 of the objective examinations that were considered minimal requirements for classifying non-SS and had undergone both the imaging examinations. The glands were considered positive for SS if they exhibited peripheral sialoectatic changes on sialography and/or hypoechoic areas, echogenic streaks and/or irregular gland margins on US. The images obtained were independently rated as SS-positive or SS-negative by three radiologists in a blind fashion and the final decision was made by consensus. Interobserver and intermodality agreement was evaluated using kappa values for sialography and parotid and/or submandibular US. RESULTS: Average kappa values for the interobserver agreement were 0.81, 0.80 and 0.82 in sialography, parotid and submandibular US, respectively, indicating very good or good agreement. The kappa value for intermodality agreement between sialography and parotid US was 0.81 and between sialography and submandibular US was 0.76, indicating very good and good agreement, respectively. The diagnostic ability of parotid US was significantly lower than that of sialography (p<0.001, McNemar test). However, the diagnostic ability of submandibular US was comparable to that of sialography (p=0.153). CONCLUSIONS: Submandibular US is a promising technique that can be used as a practical alternative to sialography in the classification of SS.

Relationship between dental occlusion and physical fitness in an elderly population.

BACKGROUND: The relationship between physical fitness and dental health status in elderly adults is still unknown. The purpose of the present study is to examine the relationship between physical fitness and occlusal condition of natural teeth in the elderly population. The sample consisted of 591 individuals aged 70 years and 158 aged 80 years selected from the registry of residents in Niigata city. METHODS: Hand grip strength (kg), leg extensor strength (kg), leg extensor power (watts), stepping rate (time per 10 seconds), and one-leg standing time with eyes open (seconds) were measured. The Eichner index was used as a measurement of occlusal condition. It was based on existing natural tooth contacts between maxilla and mandible in the bilateral premolar and molar regions and determined the three groups of classification used. In comparing physical fitness with Eichner index, multiple regression models were developed to adjust for variables such as age, gender, height, body weight, past medical history, blood pressure, serum albumin concentration, presence of lower back pain, smoking habit, marital status, and education. RESULTS: Multiple regression analyses revealed that leg extensor power (R(2) =.627, p <.05), stepping rate (R(2) =.159, p <.05), and one-leg standing time with eyes open (R(2) =.179, p <.05) showed significant correlations with the Eichner index. CONCLUSIONS: Leg extensor power, stepping rate, and one-leg standing time with eyes open are useful indicators in evaluating lower extremity dynamic strength, agility, and balance function, respectively. These findings suggest that dental occlusal condition is associated with lower extremity dynamic strength, agility, and balance function in elderly adults.

Deep extension from carcinoma arising from the gingiva: CT and MR imaging features.

BACKGROUND AND PURPOSE: CT and MR imaging are useful for evaluating the extension of carcinomas in the face and neck. We evaluated the involvement by carcinoma arising from the gingiva (ie, gingival cancer) by using CT and MR imaging. METHODS: We retrospectively examined 122 patients with squamous cell carcinoma (SCCA) in the lower (88 patients) and upper (34 patients) gingiva. Extension of SCCA into the spaces of the face and neck was evaluated with CT and MR imaging, and findings were surgically confirmed. RESULTS: Spread into the face and neck spaces occurred in 58% of patients. The buccal space was the most common site of spread, occurring in 42% of the lower and of 47% of the upper gingival cancers. Spread into the masticator space occurred from the lower gingival cancers in the molar region (20%) but not from the anterior region. Masticator space involvement from the upper gingiva was rare (4%). The retromolar triangle and buccal space immediately anterior to the ramus served as a corridor for cancer extension from the lower gingiva into the masticator space. The sublingual space (11%) was a less common site of spread from the lower gingiva. CONCLUSION: Gingival cancers spread into the masticator, buccal, and sublingual spaces depending on the primary sites in the oral cavity. An understanding of the face and neck-space anatomy is important in diagnosing cancer extension in the oral cavity gingiva and in treating patients with such disease.

Influence of dental occlusion on physical fitness decline in a healthy Japanese elderly population.

The aim of this study was to clarify the relationship between dental occlusion and physical fitness by a longitudinal survey. A sample of 348 subjects (171 men and 177 women) aged 71 was investigated by Eichner index (EI) as an occlusal condition (Class A: no loss; Class B: partial loss; Class C: complete loss) and five types of physical fitness tests and were re-examined 8 years later. The upper 50% were sampled to analyze the correlation between each physical fitness decline and the EI at the baseline by logistic regression models. Logistic regression analyses revealed that leg extensor power (Class B vs. Class A; odds ratio=OR=4.61, p=0.010) and one-leg standing time with eyes open (Class C vs. Class A; OR=4.27, p=0.031) showed significant correlations with the EI at the baseline. In this study, partial or complete loss of occlusion was associated with a decline in leg extensor power or a decrease in one-leg standing time with eyes open. These findings suggest that maintenance of dental occlusion may prevent a decrease in activities of daily living in the elderly.

Stage I and II mobile tongue carcinomas treated by external radiation and gold seed implantation.

The purpose of this study was to analyze the influence of a protocol modification, in which the use of gold seeds was extended and elective neck irradiation was applied, on the treatment results of early carcinoma of the tongue. We analyzed 225 patients with Stage I (93 patients) and Stage II (132 patients) squamous cell carcinomas of the oral tongue. We compared the results between the two periods before (171 patients) and after (54 patients) the modification. The main alterations were the expanded use of gold seeds for tumors less than 5 mm in thickness and the application of elective irradiation for T2 tumors. The 5-year primary control and survival rates improved from 81% to 97% and from 81% to 93%, respectively. The occurrence of late complications-lingual muscle and mandibular bone necroses-was found not to deteriorate after the modification. We concluded that the modification was adequate.