RESUMEN
PURPOSE: To find out if a moderate protrusion with a mandibular advancement device (MAD) can significantly increase the upper airway volume and, further, what signs and symptoms of obstructive sleep apnea (OSA) can be improved by this maneuver. METHODS: There were 58 adults diagnosed with OSA who were referred for MAD therapy. The mean apnea-hypopnea index (AHI) was 19.2 (SD 8.6). Five indicators of signs and symptoms of OSA (AHI, oxygen saturation, snoring, daytime sleepiness, and health-related quality of life) were evaluated at the baseline and after 6 months of MAD therapy. Nasal resistance and airway volume and cross-sectional areas with and without the MAD in situ were recorded. Based on AHI reduction, the treatment response was classified as complete, partial, or non-complete. Statistical analyses included the chi-square, t tests, Mann-Whitney U tests, and regression analyses (linear and logistic). RESULTS: Twenty-three patients attained a complete response (residual AHI < 5 events/h) to MAD therapy. In 13 subjects, the response was partial, and in 9 patients, it was non-complete. The complete responders were significantly younger, and they had a deeper overbite than partial/non-complete responders. A convex profile associated positively, but a vertically restricted throat and increased lower facial height associated negatively with the increase in airway volume. CONCLUSIONS: Excellent MAD therapy outcomes were achieved in most patients. Only age and deep bite had some influence on AHI reduction, indicating multifactorial nature in the response to MAD therapy.
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Avance Mandibular/instrumentación , Apnea Obstructiva del Sueño/cirugía , Ronquido/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Aparatos Ortodóncicos , Polisomnografía/métodos , Calidad de Vida , Posición Supina , Resultado del TratamientoRESUMEN
The aim of this randomised controlled trial was to assess the efficacy of stabilisation splint treatment on the oral health-related quality of life OHRQoL during a 1-year follow-up. Originally, the sample consisted of 80 patients (18 men, 62 women) with temporomandibular disorders (TMD) who had been referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, for treatment. Patients were randomly designated into splint (n = 39) and control group (n = 41). Patients in the splint group were treated with a stabilisation splint. Additionally, patients in both groups received counselling and instructions on masticatory muscle exercises. The patients filled in the Oral Health Impact Profile-14 (OHIP-14) questionnaire before treatment and at 3 months, 6 months and 1 year. At total, 67 patients (35 in the splint group vs. 32 in the control group) completed the questionnaire at baseline. The outcome variables were OHIP prevalence, OHIP severity and OHIP extent. Linear mixed-effect regression model was used to analyse factors associated with change in OHIP severity during the 1-year follow-up, taking into account treatment time, age, gender and group status. OHIP prevalence, severity and extent decreased in both groups during the follow-up. According to linear mixed-effect regression, decrease in OHIP severity did not associate significantly with group status. Compared to masticatory muscle exercises and counselling alone, stabilisation splint treatment was not more beneficial on self-perceived OHRQoL among TMD patients over a 1-year follow-up.
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Dolor Facial/psicología , Músculos Masticadores/fisiopatología , Ferulas Oclusales , Calidad de Vida/psicología , Rango del Movimiento Articular/fisiología , Síndrome de la Disfunción de Articulación Temporomandibular/fisiopatología , Adulto , Estudios Transversales , Terapia por Ejercicio , Dolor Facial/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ejercicios de Estiramiento Muscular , Dimensión del Dolor , Síndrome de la Disfunción de Articulación Temporomandibular/complicaciones , Síndrome de la Disfunción de Articulación Temporomandibular/psicología , Síndrome de la Disfunción de Articulación Temporomandibular/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Leadership skills are important in dentists' work. Leadership education already in undergraduate curriculum is noteworthy. The aim of this qualitative study was to describe dental students' visions of leadership: how they imagined they end up in leadership position, factors supporting either staying in or leaving the position and their future views. MATERIALS AND METHODS: The data were gathered after participants, fifth-year dental students, attended a "Dentist as a Leader" study module. A method of empathy-based stories was utilised. Based on contrasting frame stories, students were divided into two groups and wrote essays about an imagined situation in which they either enjoyed their leadership position ("Stayers") or considered leaving it ("Leavers"). The data were analysed using the content analysis method. RESULTS: The reasons for ending up in a leadership position were similar in the two groups: accidentally drifting into or intentionally heading for it. Factors supporting staying or leaving the leadership position were more diverse and were divided into personal and working community levels. These factors were common and group-specific. Clinical work, personal life and the ability to improve the organisations were common factors. Good working community was a "Stayer"-specific factor. "Leaver"-specific factors included loneliness, stress and lack of public sector resources. Future career plans were similar in both groups emphasising clinical work. CONCLUSIONS: After having attended leadership training, dental students were able to describe their future careers and list factors supporting either staying or leaving an imagined leadership position. These factors can be utilised by organisations to develop better working environments for future dentist leaders. By recognising the factors, students themselves are able to plan their future career choices and prepare to become leaders.
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Selección de Profesión , Educación en Odontología , Liderazgo , Estudiantes de Odontología/psicología , Adulto , Curriculum , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Mannose-binding lectin (MBL) plays an important role in innate immunity. MBL deficiency is usually caused by mutations in exon 1 of the MBL structural gene (MBL2). Our aim was to investigate MBL2 polymorphisms and their relation to salivary levels of periodontal inflammatory/tissue destruction markers and two major periodontitis-associated bacteria. MATERIAL AND METHODS: Salivary samples from 222 subjects were available for genotyping by pyrosequencing. The subjects between 40 and 60 years of age and having a minimum of 20 teeth were divided into three periodontal groups: 80 had generalized periodontitis, 65 had localized periodontitis and 77 were periodontitis-free. A comparison between their MBL2 genotypes and salivary detection rates and levels of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis as well as interleukin -1ß, matrix metalloproteinase -8, and tissue inhibitor of matrix metalloproteinase (TIMP)-1 was performed. RESULTS: The frequencies of the MBL2 wild-type (A/A), heterozygote variants (A/O) and homozygote variants (O/O) were 69.4%, 26.6% and 4%, respectively. In A. actinomycetemcomitans-positive subjects having homozygote or heterozygote MBL2 variants, the salivary concentrations of IL-1ß (p = 0.010) were elevated and those of TIMP-1 (p = 0.001) were decreased. In addition their matrix metalloproteinase -8/TIMP-1 ratio was higher (p < 0.001) and they had more pocket teeth (p = 0.012) than subjects negative for A. actinomycetemcomitans. CONCLUSION: Our findings indicate that the carriage of A. actinomycetemcomitans may facilitate extended periodontal inflammation and destruction in subjects with a variant form of human MBL2.
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Lectina de Unión a Manosa/genética , Periodontitis/genética , Polimorfismo Genético/genética , Adulto , Aggregatibacter actinomycetemcomitans , Estudios de Casos y Controles , Femenino , Predisposición Genética a la Enfermedad/genética , Técnicas de Genotipaje , Humanos , Interleucina-1beta/análisis , Masculino , Metaloproteinasa 8 de la Matriz/análisis , Persona de Mediana Edad , Porphyromonas gingivalis , Saliva/microbiología , Inhibidor Tisular de Metaloproteinasa-1/análisisRESUMEN
AIM: To assess the prevalence of apical periodontitis in the Finnish population aged 30 years and older and relate it to the technical quality of root filling by the type of tooth. METHODOLOGY: As part of the Finnish nationwide Health 2000 study, panoramic radiographs were used of the dentate subjects (n = 5335) aged 30-95 years (mean 50.2 years) to assess the apical and endodontic status of their teeth (n = 120635). Apical periodontitis (AP) was recorded when the periodontal ligament space was more than double in width, or loss of lamina dura or a periapical radiolucent lesion was seen. Technically, adequate root fillings had a gap of 0-3 mm from the apex; all others were defined as inadequate. Statistical methods included chi-square tests and anova. Risk of AP was estimated as cross-product odds ratio and its 95% confidence interval. RESULTS: Teeth with AP occurred in 27% of the dentate subjects being more prevalent in subjects with root filled teeth than in those without (39% vs. 9%; P < 0.001; OR = 6.3; 95% CI 5.3, 7.4). AP was more prevalent in men than in women (31% vs. 23%). At a tooth level, AP was most frequent in mandibular molars with inadequate root fillings. For all root filled teeth, an inadequate root filling doubled the risk of AP for both women (OR = 2.0; 95% CI 1.7, 2.4) and men (OR = 2.5; 95% CI 2.1, 2.9). CONCLUSIONS: AP occurred principally in subjects and teeth with root fillings. Inadequate root fillings doubled the risk of AP. An improvement in the technical quality of root canal treatment is essential.
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Restauración Dental Permanente , Periodontitis Periapical/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Encuestas de Salud Bucal , Fracaso de la Restauración Dental , Restauración Dental Permanente/normas , Femenino , Finlandia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Periodontitis Periapical/diagnóstico por imagen , Periodontitis Periapical/etiología , Prevalencia , Radiografía Panorámica , Tratamiento del Conducto Radicular/normasRESUMEN
OBJECTIVE: The aim was to study factors associated with staying in a dentist leadership position. PARTICIPANTS AND METHODS: We used an electronic questionnaire to gather data from 156 current or former Finnish dentist leaders in 2014. Principal component analysis categorized statements regarding time usage and opportunities in managerial work into five main components. Associations between these main component scores and the tendency to stay as a leader were analyzed with logistic regression. RESULTS: Out of the five main components, two were significantly associated with staying as a leader: 'career intentions', which represented intent to continue or to leave the leadership position; and 'work time control opportunities', which represented how leaders could control their own work time. Other factors that supported staying were leadership education, more work time available for leadership work, and lower age. The main component 'work pressure' decreased, although not significantly, the odds of continuing; it included lack of leadership work time, and pressure from superiors or subordinates. CONCLUSIONS: Leaders have important roles in health care, ensuring everyday operations as well as developing their organizations to meet future challenges. Knowledge of these supporting factors will enable dentist leaders and their organizations to improve working conditions in order to recruit and retain motivated and competent persons. In addition, well-designed education is important to inspire and encourage future leaders.
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Odontólogos , Liderazgo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , AutoinformeRESUMEN
AIM: To evaluate the self-reported oral health habits and their association with the occurrence of dental caries among children in Pyongyang, Democratic People's Republic of Korea (DPRK), after 6 years of activities under the auspices of the Children's Oral Health Promotion Programme (COHPP). METHODS: The data were collected in September 2013 in two of the most central districts of Pyongyang City, DPRK. The sample consisted of 492 children aged 10 and 13 years who had participated in the COHPP for 6 years. The children filled in a self-completed, structured questionnaire on oral health habits and were examined clinically by a dentist. The differences in mean (SD) number of decayed primary (dt) and permanent teeth (DT) and their sum (dt + DT) subdivided according to genders, age groups, districts and self-reported oral health habits were evaluated using Mann-Whitney U-test. The associations between self-reported oral health habits and the occurrence of dental caries were evaluated with chi-square test and logistic regression analyses. RESULTS: The school-aged children commonly reported healthy oral hygiene habits but sweet snacks were commonly used. The occurrence of dental caries associated statistically significantly with the frequency of sweet snacking (p=0.011) but not with the frequency of tooth brushing (p=0.725) or the use of water for thirst instead of sugary beverages (p=0.189). CONCLUSION: A more effective promotion of healthy dietary habits with innovative approaches and close collaboration with different social actors will be needed in future.
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Caries Dental/epidemiología , Hábitos , Salud Bucal , Adolescente , Niño , Índice CPO , República Popular Democrática de Corea/epidemiología , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The aim was to compare the change in dental caries status in two different intervention groups of the Children's Oral Health Promotion Programme (COHPP). METHODS: A longitudinal study among 500 children who had participated into the COHPP for 6 years was conducted in Pyongyang, Democratic People's Republic of Korea (DPRK). Children in Group I received intensified school-based intervention and were clinically examined at the age of 7 years in 2007 (n = 250), 10 years in 2010 (n = 250) and 13 years in 2013 (n = 242). Children in Group II (n = 250) joined the programme at the age of 4 years in kindergarten in 2007, were provided with early preschool-based intervention and were clinically examined at the age of 7 years in 2010 and 10 years in 2013. RESULTS: Both the prevalence and the mean number of dt + DT decreased significantly in both groups during the follow-up. This was due to decrease in the number of dt, whereas the number of DT remained relatively constant. Poisson regression showed that the association between the group status and the change in the number of dt + DT was statistically significant when adjusted for gender but disappeared when the school was included in the analysis. CONCLUSIONS: The decrease in dental caries may be partly due to the exfoliation of deciduous teeth and dental treatment received. However, the study gave some reference emphasizing the early starting of the prevention.
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Caries Dental/prevención & control , Adolescente , Niño , Preescolar , República Popular Democrática de Corea/epidemiología , Caries Dental/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Servicios de Salud EscolarRESUMEN
The aim of this randomised controlled trial was to assess the efficacy of stabilisation splint treatment on TMD-related facial pain during a 1-year follow-up. Eighty patients were randomly assigned to two groups: splint group (n = 39) and control group (n = 41). The patients in the splint group were treated with a stabilisation splint and received counselling and instructions for masticatory muscle exercises. The controls received only counselling and instructions for masticatory muscles exercises. The outcome variables were the change in the intensity of facial pain (as measured with visual analogue scale, VAS) as well as the patients' subjective estimate of treatment outcome. The differences in VAS changes between the groups were analysed using variance analysis and linear regression models. The VAS decreased in both groups, the difference between the groups being not statistically significant. The group status did not significantly associate with the decrease in VAS after adjustment for baseline VAS, gender, age, length of treatment and general health status. The only statistically significant predicting factor was the baseline VAS, which was also confirmed by the mixed-effect linear model. After 1-year follow-up, 27.6% of the patients in the splint group and 37.5% of the patients in the control group reported 'very good' treatment effects. The findings of this study did not show stabilisation splint treatment to be more effective in decreasing facial pain than masticatory muscle exercises and counselling alone in the treatment of TMD-related facial pain over a 1-year follow-up.
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Dolor Facial/terapia , Ferulas Oclusales , Síndrome de la Disfunción de Articulación Temporomandibular/terapia , Adulto , Consejo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Resultado del TratamientoRESUMEN
Systemic metabolic signatures of oral diseases have been rarely investigated, and prospective studies do not exist. We analyzed whether signs of current or past infectious/inflammatory oral diseases are associated with circulating metabolites. Two study populations were included: the population-based Health-2000 (n = 6,229) and Parogene (n = 452), a cohort of patients with an indication to coronary angiography. Health-2000 participants (n = 4,116) provided follow-up serum samples 11 y after the baseline. Serum concentrations of 157 metabolites were determined with a nuclear magnetic resonance spectroscopy-based method. The associations between oral parameters and metabolite concentrations were analyzed using linear regression models adjusted for age, sex, number of teeth, smoking, presence of diabetes, and education (in Health-2000 only). The number of decayed teeth presented positive associations with low-density lipoprotein diameter and the concentrations of pyruvate and citrate. Negative associations were found between caries and the unsaturation degree of fatty acids (FA) and relative proportions of docosahexaenoic and omega-3 FAs. The number of root canal fillings was positively associated with very low-density lipoprotein parameters, such as diameter, cholesterol, triglycerides, and number of particles. Deepened periodontal pockets were positively associated with concentrations of cholesterol, triglycerides, pyruvate, leucine, valine, phenylalanine, and glycoprotein acetyls and negatively associated with high-density lipoprotein (HDL) diameter, FA unsaturation degree, and relative proportions of omega-6 and polyunsaturated FAs. Bleeding on probing (BOP) was associated with increased concentrations of triglycerides and glycoprotein acetyls, as well as decreased proportions of omega-3 and omega-6 FAs. Caries at baseline predicted alterations in apolipoprotein B-containing lipoproteins and HDL-related metabolites in the follow-up, and both caries and BOP were associated with changes in HDL-related metabolites and omega-3 FAs in the follow-up. Signs of current or past infectious/inflammatory oral diseases, especially periodontitis, were associated with metabolic profiles typical for inflammation. Oral diseases may represent a modifiable risk factor for systemic chronic inflammation and thus cardiometabolic disorders.
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Colesterol , Ácidos Grasos , Humanos , Estudios Prospectivos , Triglicéridos , Lipoproteínas LDL , Inflamación , Glicoproteínas , PiruvatosRESUMEN
BACKGROUND: Fish consumption and omega-3 polyunsaturated fatty acid (PUFA) intake are shown to protect from cardiovascular diseases (CVD). However, most fish contain environmental contaminants such as dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), and methylmercury (MeHg) that may have adverse effects on cardiovascular health. OBJECTIVE: Our aim was to elucidate the associations of fish consumption, omega-3 PUFAs, environmental contaminants with low-grade inflammation, early atherosclerosis, and traditional CVD risk factors. METHODS: The Health 2000 survey participants (n=1173) represented the general Finnish population and the Fishermen study participants (n=255) represented a population with high fish consumption and high exposure to environmental contaminants. Model-adjusted geometric means and tests for linear trend were calculated for CVD risk factors by tertiles of fish consumption and serum omega-3 PUFAs, and additionally in the Fishermen study only, by tertiles of serum PCDD/F+PCB, and blood MeHg. RESULTS: Serum triglyceride decreased across omega-3 PUFA tertiles in both sexes and studies. Insulin resistance, C-reactive protein, tumour necrosis factor α, and interleukin 6 decreased across omega-3 PUFA tertiles among the Health 2000 survey participants. Among the Fishermen study men, insulin resistance and arterial stiffness indicated by ß-stiffness index tended to increase and the RR estimate for carotid artery plaque tended to decrease across tertiles of PCDD/F+PCB and MeHg. CONCLUSION: Previously established hypotriglyceridemic and anti-inflammatory effects of omega-3 PUFAs were seen also in this study. The hypothesised favourable effect on insulin sensitivity and arterial elasticity was suggested to be counteracted by high exposure to environmental contaminants but the effect on plaque prevalence appeared not to be harmful.
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Aterosclerosis/inducido químicamente , Dieta/estadística & datos numéricos , Contaminantes Ambientales/efectos adversos , Ácidos Grasos Omega-3/sangre , Inflamación/inducido químicamente , Alimentos Marinos/estadística & datos numéricos , Adulto , Anciano , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Studies concerning the role of denture status on in temporomandibular disorders (TMD) are scarce. The aim of this study was to evaluate the association of tooth loss and denture status with clinical findings of TMD. The data were obtained from 6316 subjects aged ≥ 30 years from the Finnish Health 2000 Survey. The associations between clinically assessed TMD findings and number of teeth, wearing of removable dentures, need for denture repair and age of the dentures were analysed by means of chi-square test and logistic regression. Among women after adjusting for age, having fewer teeth or wearing complete dentures associated with restricted maximum interincisal distance and pain on palpation of the temporomandibular joints (TMJ) and masticatory muscles. After adding education level and depression in the model, the associations between TMJ pain and explanatory variables were weakened. Among men, having a higher number of teeth associated with occurence of TMJ crepitation. Subjective need for repair of dentures and having a denture aged ≥ 5 years associated with pain on palpation in masticatory muscles among women. Among men, both the objective and subjective need for denture repair and having at least one denture aged ≥ 5 years or been repaired during the past 5 years associated negatively with the presence of TMJ crepitation. It can be concluded that edentulousness, wearing of complete dentures and poor condition of dentures associate with pain-related TMD findings among women. Psychosocial factors have a modifying effect on these associations.
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Dentaduras/estadística & datos numéricos , Síndrome de la Disfunción de Articulación Temporomandibular/epidemiología , Pérdida de Diente/epidemiología , Adulto , Anciano , Dolor Facial/epidemiología , Femenino , Humanos , Masculino , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Factores de TiempoRESUMEN
Personality is one of the strongest predictors of subjective well-being and may, according to a few previous studies, affect how people report oral health-related quality of life (OHRQoL). Alexithymia, a personality trait involving difficulties in emotional regulation, is associated with poorer health-related quality of life in the general population. We studied if alexithymia is also associated with poorer OHRQoL in a general population sample of 4,460 adults. Oral health-related quality of life was measured using the 14-item Oral Health Impact Profile (OHIP-14) and alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Controlling for clinically assessed dental health, depression, anxiety, and socio-demographic variables, higher scores on the TAS-20 as well as on its three dimensions [difficulties in identifying feelings (DIF), difficulties in describing feelings (DDF), and externally oriented thinking (EOT)] were associated with higher OHIP-14 composite scores according to Poisson regression analyses. In adjusted logistic regression analyses, the TAS-20 and two of its dimensions (DIF and DDF) were positively and significantly associated with the seven OHIP-14 dimensions and the prevalence of those reporting one or more OHIP-14 items fairly often or very often. The study showed that difficulties in emotional regulation might be reflected in poorer OHRQoL, regardless of the dental health status, depression, anxiety, and socio-demographic variables.
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Síntomas Afectivos/complicaciones , Salud Bucal , Personalidad , Calidad de Vida/psicología , Adulto , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/psicología , Emociones , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This study assesses whether sense of coherence (SOC) predicts incidence of tooth decay over 4 years and the role of dental behaviours in explaining the effect of SOC on incidence of tooth decay. Data from 994 adults who participated in both the Health 2000 survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed for this study. At baseline, participants provided information on demographic characteristics, education level, the SOC scale and dental behaviours (tooth brushing frequency, dental attendance and sugar intake frequency). The 4-year incidence of tooth decay was calculated using data from baseline and follow-up clinical oral examinations. Baseline SOC was significantly related to 4-year incidence of tooth decay after adjustment for demographic factors and education (relative risk: 0.79, 95% CI: 0.63-0.98). This effect was fully attenuated after further adjustment for the three dental behaviours. Tooth brushing frequency and dental attendance were the only dental behaviours significantly related to incidence of tooth decay. This prospective study suggests that SOC predicts incidence of tooth decay and that dental behaviours may help explaining why adults with strong SOC have lower risk of developing tooth decay than those with weak SOC.
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Caries Dental/epidemiología , Caries Dental/psicología , Conductas Relacionadas con la Salud , Sentido de Coherencia , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Dieta , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Encuestas y Cuestionarios , Cepillado Dental/estadística & datos numéricosRESUMEN
Genetic risk factors play important roles in the etiology of oral, dental, and craniofacial diseases. Identifying the relevant risk loci and understanding their molecular biology could highlight new prevention and management avenues. Our current understanding of oral health genomics suggests that dental caries and periodontitis are polygenic diseases, and very large sample sizes and informative phenotypic measures are required to discover signals and adequately map associations across the human genome. In this article, we introduce the second wave of the Gene-Lifestyle Interactions and Dental Endpoints consortium (GLIDE2) and discuss relevant data analytics challenges, opportunities, and applications. In this phase, the consortium comprises a diverse, multiethnic sample of over 700,000 participants from 21 studies contributing clinical data on dental caries experience and periodontitis. We outline the methodological challenges of combining data from heterogeneous populations, as well as the data reduction problem in resolving detailed clinical examination records into tractable phenotypes, and describe a strategy that addresses this. Specifically, we propose a 3-tiered phenotyping approach aimed at leveraging both the large sample size in the consortium and the detailed clinical information available in some studies, wherein binary, severity-encompassing, and "precision," data-driven clinical traits are employed. As an illustration of the use of data-driven traits across multiple cohorts, we present an application of dental caries experience data harmonization in 8 participating studies (N = 55,143) using previously developed permanent dentition tooth surface-level dental caries pattern traits. We demonstrate that these clinical patterns are transferable across multiple cohorts, have similar relative contributions within each study, and thus are prime targets for genetic interrogation in the expanded and diverse multiethnic sample of GLIDE2. We anticipate that results from GLIDE2 will decisively advance the knowledge base of mechanisms at play in oral, dental, and craniofacial health and disease and further catalyze international collaboration and data and resource sharing in genomics research.
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Caries Dental , Periodontitis , Caries Dental/genética , Caries Dental/prevención & control , Genómica , Humanos , Salud Bucal , FenotipoRESUMEN
Our aims were to document the occurrence of neurosensory disturbances of the infraorbital nerve six months after operation for an orbital blow-out fracture, and to find out whether dexamethasone facilitates neurosensory regeneration. Patients were randomly assigned to one of two groups: the study group was given a total of dexamethasone 30mg, whereas the control group were given neither glucocorticoid nor placebo. Each patient's infraorbital neurosensory state was recorded preoperatively, immediately postoperatively, and six months later. A total of 18 patients were included, eight of whom had neurosensory disturbances six months after the initial trauma that was not affected by dexamethasone. Six of the seven patients who had a delay of seven days or more between trauma and operation had significantly prolonged disturbance at the 180-day clinical follow up compared with those in whom it was less than seven days (p=0.005). Other possible predictors made no significant difference. Although dexamethasone did not facilitate sensory recovery, its benefits in the management of pain and reduction of swelling may justify its use in the management of facial trauma in selected patients.
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Dexametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Órbita/inervación , Fracturas Orbitales/cirugía , Complicaciones Posoperatorias/prevención & control , Trastornos Somatosensoriales/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Método Simple Ciego , Resultado del TratamientoRESUMEN
The purpose of this study was to assess clinical and radiographic signs of disease in third molars within a population that is representative of the Finnish adult population aged 30 years and older. A two-stage stratified cluster sampling method was used to collect the 6005 subjects, who were examined clinically and also by panoramic radiography. The state of impaction, presence of dentinal caries and/or restorations, presence of root canal fillings, periodontal pocket depth, and additional pathological findings such as over-eruption and widened follicle were assessed. Signs of disease in the third molars were found in 47% of the adult population and in 97% of those subjects with third molars. At least one sign of disease occurred in 82% of erupted third molars compared to 74% of those impacted in soft tissue and 33% impacted in bone (P<0.001). A diseased third molar was more often located in the mandible (60%) than in the maxilla (40%) (P<0.001), and was more often found in men (57%) than in women (43%) (P<0.05). It is concluded that signs of disease in third molars in the target population are more common than has been reported previously.
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Tercer Molar/diagnóstico por imagen , Tercer Molar/patología , Enfermedades Dentales/diagnóstico por imagen , Enfermedades Dentales/epidemiología , Adulto , Anciano , Femenino , Finlandia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Radiografía PanorámicaRESUMEN
OBJECTIVES: Glucocorticoids are widely used in association with major surgery of the head and neck to improve postoperative rehabilitation, shorten intensive care unit and hospital stay, and reduce neck swelling. This study aimed to clarify whether peri- and postoperative use of dexamethasone in reconstructive head and neck cancer surgery is associated with any advantages or disadvantages. MATERIALS AND METHODS: This prospective double-blind randomized controlled trial comprised 93 patients. A total dose of 60mg of dexamethasone was administered to 51 patients over three days peri- and postoperatively. The remaining 42 patients served as controls. The main primary outcome variables were neck swelling, length of intensive care unit and hospital stay, duration of intubation or tracheostomy, and delay to start of possible radiotherapy. Complications were also recorded. RESULTS: No statistical differences emerged between the two groups in any of the main primary outcome variables. However, there were more major complications, especially infections, needing secondary surgery within three weeks of the operation in patients receiving dexamethasone than in control patients (27% vs. 7%, p=0.012). CONCLUSIONS: The use of dexamethasone in oral cancer patients with microvascular reconstruction did not provide a benefit. More major complications, especially infections, occurred in patients receiving dexamethasone. Our data thus do not support the use of peri- and postoperative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction.
Asunto(s)
Dexametasona/uso terapéutico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Microcirculación , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Procedimientos de Cirugía PlásticaRESUMEN
This study aimed to establish the incidence of postoperative nausea and vomiting (PONV) in facial fracture patients. The specific aim was to investigate the effect of perioperative dexamethasone on PONV. A total of 119 adult patients with facial fractures were analysed in this prospective study. Patients were randomized to receive perioperatively either a total dose of 30mg of dexamethasone i.v. and i.m., or no glucocorticoid (control). PONV was evaluated every 6hours during the first postoperative 24hours and when pain medications were given. PONV occurred in 20 out of 119 patients (16.8%). The only significant (P=0.016) association with PONV was postoperative administration of opioids. Slightly more cases of PONV occurred for patients who had not received dexamethasone (20%) compared to those who had (13.6%). PONV was also non-significantly more common in patients ≥40 years (21.3%) than in patients < 40 years (12.1%), after orbital floor reconstruction (28.0%) compared with mandibular (11.6%) and zygomatic (15.6%) fractures surgeries, and also after anaesthesia lasting >97minutes (21.7%) compared with a shorter duration (11.3%). Alternative medications should be used for prevention of post-surgery nausea and vomiting in facial fracture patients.
Asunto(s)
Antieméticos/uso terapéutico , Dexametasona/uso terapéutico , Traumatismos Faciales/cirugía , Fijación Interna de Fracturas/métodos , Náusea y Vómito Posoperatorios/prevención & control , Fracturas Craneales/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To study differences in consumption of foods and intake of nutrients attributable to denture status. DESIGN, SETTING AND PARTICIPANTS: Data from a cross-sectional, nationally representative Health 2000 Survey, subjects aged 55-84 years (n=2,241). MEASUREMENTS: Denture status (edentulous with full dentures, own dentition with removable dentures, own dentition with no removable dentures) was used as an explanatory variable. The consumption of foods and intake of nutrients was used as an outcome variable and was measured using a validated Food Frequency Questionnaire. RESULTS: Denture status associated with food choices. Full denture wearers consumed less vegetables (p = 0.013 among men and p = 0.001 among women) and fruits (p = 0.001 among women), more sugary products (p = 0.012 among men and p = 0.008 among women), and their balance in fatty acids was less favourable than among dentate participants. Among dentate participants, the differences between the two groups were small and statistically significant differences were seen mostly in women. CONCLUSIONS: Wearing full dentures appears to be associated with unhealthier food choices, lower consumption of some foodstuffs and lower intake of certain nutrients when compared to the food choices of dentate persons.