Circadian rhythms and influencing factors of xerostomia among Parkinson's disease patients.

OBJECTIVES: Parkinson's disease (PD) patients suffer from xerostomia, but limited information exists regarding associations with dysphagia, drooling, daily habits, PD characteristics, or possible circadian rhythms. SUBJECTS AND METHODS: A questionnaire was administered, including (a) clinical characteristics (comorbidities, prescribed medications, levodopa equivalent daily dose [LEDD], disease duration); (b) self-assessment of dysphagia, xerostomia, drooling (10-cm visual analogue scale [VAS]); (c) 24-hr diary of motor impairment, dyskinesia, xerostomia, dysphagia, drooling, daily habits. RESULTS: Of 75 PD patients who completed the study, 67% reported dysphagia (mean ± standard deviation VAS 4 ± 2), 76% drooling (5 ± 2), 77% xerostomia (5 ± 2). Xerostomia was associated with comorbidities (p = 0.021) and smoking (p = 0.010) and affected by tremor (p = 0.003), dyskinesia (p = 0.010), dysphagia (p < 0.001), food intake (p = 0.005), sleep (p = 0.011), age (p = 0.018), medication intake (p = 0.063), LEDD (p = 0.052), daytime (p = 0.075), disease duration (p = 0.004). Xerostomia peaked at 9 a.m. and 9 p.m. CONCLUSIONS: PD patients suffer from xerostomia, dysphagia, and drooling. Subjective dysphagia is associated with drooling and xerostomia, but drooling prevalence or intensity does not influence xerostomia symptoms. Tremor, dyskinesia, and disease duration, which characterise PD, affect xerostomia. Additionally, food intake, sleep, age, LEDD, and daytime (peaks at 9 a.m. and 9 p.m.) increase xerostomia occurrence. This knowledge may improve dentists' advice to patients and aid development of patient-centred, symptom-relieving products.

Subjective and objective halitosis among patients with Parkinson's disease.

OBJECTIVES: Parkinson's disease (PD) affects oral health, but prevalence of subjective and objective halitosis and the influence of hyposalivation remain unclear. We aimed to explore whether patients with PD suffer from halitosis and to define correlations between halitosis and hyposalivation. We hypothesised that patients with PD suffer more often from halitosis compared to healthy controls, influenced by dry mouth. MATERIALS AND METHODS: Subjective (halitosis, xerostomia visual analogue scale [VAS], short German Oral Health Impact Profile [OHIPG]-14) and objective scales (e.g., organoleptic score, volatile sulphur compounds [VSCs], stimulated whole saliva [SWS]) were assessed from 26 patients with PD and 26 healthy controls. RESULTS: The mean organoleptic score was 0.7 (SD: 0.7) in all patients, and VSCs were either comparable or significantly lower (dimethyl sulphide, P = .010) in PD patients compared with controls, yet more patients with PD perceived halitosis to be stronger (77% vs 54%, respectively; P = .059). Dry mouth was significantly more likely in patients with PD than controls: mean xerostomia VAS 4 (SD: 2) vs 1 (SD: 2), P = .010; SWS 0.4 (SD: 0.4) vs 0.7 (SD: 0.6) mL/min, P < .05); SWS did not correlate with subjective or objective halitosis. Oral health-related quality of life (OHRQoL) was lower in patients with PD than controls (mean OHIPG-14 score 12 (SD: 0.2) vs 5 (SD: 7.0), respectively; P < .05). CONCLUSIONS: Patients with PD suffer from subjective and objective halitosis, dry mouth and impaired OHRQoL. Dry mouth problems do not correlate with prevalence or intensity of halitosis.

Tracheal intubation with the Bonfils fiberscope in the difficult pediatric airway: a comparison with fiberoptic intubation.

BACKGROUND: Fiberoptic intubation (FOI) is the gold standard for the tracheal intubation in adults with a difficult airway. However, this technique is more difficult in the narrow pediatric airway and the evaluation of alternative devices in children remains desirable. The Bonfils fiberscope (BF) is well described for the difficult airway, but no clinical data assessing its use in the difficult pediatric airway are available. METHODS: A controlled clinical study was conducted comparing BF and FOI in children and infants requiring tracheal intubation with a suspected difficult airway or who demonstrated a difficult airway which was unanticipated. Time to successful intubation, quality of imaging and ease of the intubation procedure were determined. RESULTS: A total of 26 patients (46% infants) were studied, and all successfully intubated at the first attempt using either the BF or FOI. Mouth opening was restricted in 38% of patients. Time required for intubation was shorter with the BF (52 ± 22 s) compared with the FOI (83 ± 24 s, P = 0.008). The image quality (excellent in 73% vs. 45%, P = 0.129) and the ease of the procedure (excellent in 67% vs. 18%, P = 0.015) were considered better with BF than with FOI. CONCLUSION: Although both the BF and FOI are suitable devices for the intubation of infants and children with difficult airways, the BF may allow faster tracheal intubation with a better image quality and ease of use.

Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial.

AIM: Compare the treatment outcome after scaling and root-planing using local anesthesia gel or injected local anesthesia. MATERIAL AND METHOD: Thirty-eight patients with periodontitis and good general health were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6 weeks after treatment. Performed treatment procedures were scaling and root planing using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. Patients' pain perception and anesthesia acceptance were recorded on questionnaires. RESULTS: No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (p > 0.05). These findings are valid even for deeper pockets. Gel-group had significant higher intra-operative pain perception. In retrospect 69% of patients favored gel. CONCLUSION: Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort.

Determining the optimal frequency of SARS-CoV-2 regular asymptomatic testing: A randomized feasibility trial in a home care setting.

BACKGROUND: The SARS-CoV-2 pandemic presented a challenge for caregiving relatives in the home care setting. Caregivers can transmit SARS-CoV-2 to their relatives who are often at high risk for a severe course of COVID-19. Regular testing of asymptomatic caregivers for SARS-CoV-2 may reduce the risk of transmission. The optimal method and frequency of regular asymptomatic testing is unknown. We conducted a prospective, randomised trial to assess the feasibility, recruitment and acceptance of different testing frequencies. This serves to inform a future definitive randomised controlled trial. METHODS: We carried out a parallel three-armed feasibility trial, enrolling adult participants who provided home-based care for a relative at least twice a week. Participants were randomly assigned using sealed envelopes to either conduct saliva-based antigen self-testing at a frequency of once a week (group I), twice a week (group II), or every two days (group III). The participants completed questionnaires on a weekly basis. Main outcome measures were feasibility of recruitment, adherence to self-tests and distress caused by self-testing. We further collected data on the use of mouth-nose mask. RESULTS: From 25 March to 7 May 2021 we assessed 27 participants and randomised 26 in the study: 8 participants in group I, 8 in group II and 10 in group III. All participants completed the study. In group I 48/48 (100.0%; 95% CI 92.6% to 100.0%), in group II 93/96 (96.9%; 95% CI 91.2% to 98.9%) and in group III 209/210 (99.5%; 95% CI 97.4% to 99.9%) self-tests were carried out at home. Participants did not perceive regular self-testing as burdensome in any of the study arms. We did not observe any infection with SARS-CoV-2. During the study, mask adherence decreased from 35% to 19% in all groups. CONCLUSION: Conducting such a study was feasible. The participants tolerated regular self-testing well, which was reflected in a high level of test adherence. However, regular self-testing may have led to decreased protective behaviour. To demonstrate that regular asymptomatic testing reduces infection transmission, a future definitive trial should be performed at a time of a high prevalence of SARS-CoV-2 and be implemented as a multicentre study. TRIAL REGISTRATION: The trial is registered with the German Clinical Trials Register, DRKS00026234.

The impact of periodontal treatment on healthcare costs in newly diagnosed diabetes patients: Evidence from a German claims database.

AIMS: There is sufficient scientific evidence for the bidirectional association between periodontal diseases and diabetes. In this context, we hypothesized that periodontal treatment leads to lower healthcare costs in newly diagnosed diabetes patients by promoting a milder disease course. METHODS: A total of 23,771 persons were investigated who were continuously insured by German health insurances between 2011 and 2016, 18 years or older, and newly diagnosed with diabetes in 2013. The study population was divided into a periodontal treatment and control group (no periodontal treatment). The average treatment effect of a periodontal treatment on various types of healthcare costs (inpatient, outpatient, drug costs) was analyzed by a doubly robust method. RESULTS: Finally, 5.3% of the study population could be assigned to the treatment group. In newly diagnosed diabetes patients with periodontal treatment, a reduction in total healthcare costs (0.96, 95%CI 0.89; 1.04), inpatient costs (0.87, 95%CI 0.69; 1.08), diabetes-related drug costs (0.93, 95%CI 0.84; 1.03) and other drug costs (0.97, 95%CI 0.89; 1.05) could be shown compared to the control group. CONCLUSIONS: This study provides evidence that periodontal treatment for diabetes patients reduces healthcare costs. Fewer diabetes-specific complications and hospitalizations are expected.

Degradation of poly-L/DL-lactide versus TCP composite pins: a three-year animal study.

Biodegradable polylactide implants allow secure fixation of osteochondral fractures. This quasirandomized parallel-group animal study investigates whether a composite implant of poly-L/DL-lactide (PLDLLA) with additional 10% beta-tricalcium phosphate produces an osteoconductive effect, whether the admixture positively influences implant degradation (assessed by comparing time to implant degradation), and whether the pin sites of degraded implants are replaced with bone tissue. On 36 medial femoral condyles of sheep, osteotomies were fixed with either three PLDLLA pins or three composite pins. At 3, 18, and 36 months, the pin sites were measured histologically and the state of degradation assessed according to Pistner's classification. All fractures healed without clinically relevant complications and without displacement. Both pin types led to asymptomatic pin-site enlargement at 18 months, which disappeared by 36 months. At 18 months, 14 of 18 PLDLLA pins were no longer evident, whereas 16 of 18 composite pins showed only peripheral degradation. By 36 months, all implants from both groups were completely degraded and replaced with scar (2/18) or bone tissue (16/18). At 36 months there was no evidence for significant improvement of either degradation performance or osseointegration through use of the 10% TCP composite mixture.

Clinical trial to evaluate the performance of a flexible self-adherent absorbent dressing coated with a soft silicone layer compared to a standard wound dressing after orthopedic or spinal surgery: study protocol for a randomized controlled trial.

BACKGROUND: Postoperative wound infection is a preventable risk. One potential postoperative complication is blistering, which leads to increased pain, delayed healing, and higher care costs. The incidence of wound blisters has been reported to be between 6 and 24%. The aim of this study is to assess whether the risks of postoperative blistering and wound infections within the first 6 days postsurgery will be reduced using a special dressing compared to a standard one. METHODS/DESIGN: This is a randomized clinical trial in a University hospital. Patients presenting for knee or hip arthroplasty or spine procedures will be assessed against study inclusion and exclusion criteria. After giving written informed consent, patients will be randomized to participate in the 7-day study during hospitalization. One hundred patients will be randomized per group. The primary outcome measure is blistering incidence from day 0 to day 6 postsurgery. Photo documentation will be evaluated in a blinded manner by the Clinical Evaluation Committee (CEC). DISCUSSION: A new dressing will be compared to the standard wound dressing regarding the risk of postoperative blistering, wound infection, and patient comfort. This study will assess the potential advantages of a modern wound dressing. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01988818 (Entered 13 November 2011).

The growth of Staphylococcus aureus and Escherichia coli in low-direct current electric fields.

Electrical potentials up to 800 mV can be observed between different metallic dental restorations. These potentials produce fields in the mouth that may interfere with microbial communities. The present study focuses on the impact of different electric field strengths (EFS) on the growth of Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922) in vitro. Cultures of S. aureus and E. coli in fluid and gel medium were exposed to different EFS. Effects were determined by calculation of viable counts and measurement of inhibition zones. In gel medium, anodic inhibition zones for S. aureus were larger than those for E. coli at all field strength levels. In fluid medium, the maximum decrease in the viable count of S. aureus cells was at 10 V⋅m(-1). Field-treated S. aureus cells presented ruptured cell walls and disintegrated cytoplasm. Conclusively, S. aureus is more sensitive to increasing electric field strength than E. coli.

Exposure of orbital implants wrapped with polyester-urethane after enucleation for advanced retinoblastoma.

PURPOSE: Enucleation is the main form of treatment for advanced retinoblastoma. The major complication of this procedure is orbital implant exposure. Different implants and wrapping materials are currently in use. The aim of the current study was to analyze the complications associated with the use of polyester-urethane, an artificial dura substitute, as a wrapping material for enucleation in advanced retinoblastoma. METHODS: A retrospective review of 32 cases (28 patients), who were treated with enucleation for advanced retinoblastoma, was performed. The age of the patients ranged between 3 months and 6.7 years (median, 19 months). Additional chemotherapy was administered in 12 cases. The removed eyeball was replaced either with a silicone implant and polyester-urethane wrapping (13 cases) or hydroxyapatite, silicone-hydroxyapatite, or polyethylene implants without additional wrappings (19 cases). The follow-up period ranged from 7 months to 5.9 years (median, 22.4 months). Statistical analysis was performed using the Kaplan-Meier method. RESULTS: Single or multiple exposures occurred in 22% of cases (7/32). There were 6 exposures (46%, 6/13) in the group with polyester-urethane wrapping compared with only 1 exposure (5%, 1/19) in the implants without wrapping. This difference was statistically significant (p=0.0236). None of the other analyzed factors (additional chemotherapy, surgeon, age of the patient, or size of the implant) demonstrated a significant correlation to implant exposures. CONCLUSIONS: Wrapping of orbital implants with polyester-urethane resulted in a high rate of implant exposures after enucleation for advanced retinoblastoma. In this series, the best results were achieved with integrated implants without additional wrapping.

Detection of marginal defects of composite restorations with conventional and digital radiographs.

The purpose of this study was to determine the validity of detecting approximal imperfections of composite fillings using three intraoral radiographic systems in vitro. Class II composite resin restorations (108) with three radiopacities (264, 306, 443% Al 99.5) of which 27 had marginal openings or overhangs, respectively, were conventionally (Ektaspeed plus) and digitally (Dexis, Digora) radiographed. Images were assessed by 10 observers for the presence of marginal gaps and overhangs, as well as for their need of restorative treatment according to a five-point confidence rating scale. The validity of the observations were expressed as areas under receiver operating characteristic (ROC) curves (Aroc). Repeated measures analysis of variance revealed significant effects of 'radiographic system' and 'diagnostic purpose'. Marginal overhangs (Aroc = 0.90) were significantly easier to diagnose than openings (Aroc = 0.63). Marginal gaps were better detected on conventional and Dexis radiographs than on Digora images. the range of sensitivities and specificities of the treatment decision was 0.53-0.56 and 0.87-0.88, respectively. It was concluded that the validity of detecting marginal defects of composite resin restorations based on radiographs was only slightly affected by the radiographic system being used. The diagnosis of marginal gaps frequently resulted in false-positive and false-negative decisions.

The validity of proximal caries detection using magnifying visual aids.

The purpose of this study was to determine the validity of proximal caries detection supported by a prism loupe and a surgical microscope used by examiners having different professional experience. One hundred and sixty extracted premolars and molars with varying degrees of proximal caries or sound surfaces were embedded in 10 pairs of models with proximal tooth contacts and a simulated gingiva mask. The proximal surfaces were visually evaluated by 14 observers (7 students, 7 dentists) according to a 5-point caries rating scale using a head-worn prism loupe (x4.5), a surgical microscope (x 14) and without any magnifying device (control). The validity of observations was expressed as ROC curves calculated for two gold standard thresholds: (a) the presence of caries and (b) macroscopic cavitation. Repeated measures analysis of variance was used to determine the effects of 'observer group' and 'diagnostic modality'. An influence of the observer group could not be demonstrated (p > 0.72), whereas significant differences were revealed between the diagnostic modalities (p < 0.002). ROC areas of caries detection with magnifying aids were smaller compared to the control group. It was concluded that the use of a prism loupe or a surgical microscope does not improve the validity of proximal caries detection if the operators, irrespective of being dental students or clinical instructors, are inexperienced in its utilisation. In general only moderate validity was achieved with visual inspection of proximal sites.