Lower face asymmetry as a marker for developmental instability.

OBJECTIVES: Fluctuating asymmetries in the craniofacial skeleton have been shown to be predictive for mortality from degenerative diseases. We investigate whether lower face asymmetries are a potential marker for the developmental origins of health and disease. METHODS: The lower face of a representative sample of 6654 12- to 17-year old United States (US) adolescents (1966-1970, National Health Examination Survey III) was classified as asymmetric when the mandibular teeth occluded prognathically (forward) or retrognathically (backward) on one side of the face only. It was investigated whether these lower face asymmetries were directional (preferentially to the left or the right) or fluctuating (random left-right distribution) in the US population. RESULTS: Lower face asymmetries affected 1 in 4 of the US adolescents. Unilateral retrognathic dental occlusions were fluctuating asymmetries, had a US prevalence of 17.0% (95% confidence interval: 15.5-18.4) and were associated with race/ethnicity (P < .0001), not with handedness (P < .7607). Unilateral prognathic dental occlusions were directional asymmetries (P < .0001), had a US prevalence of 7.6% (95% confidence interval: 6.4-8.7) and were associated with large household size (P < .001) and handedness (P < .0223). Lower face asymmetries were not associated with distinct heritable traits such as color blindness. CONCLUSIONS: The findings suggest that lower face asymmetries are a marker for environmental stress and cerebral lateralization during early development.

Phenotypic characteristics of adolescents with concave and convex facial profiles - The National Health Examination Survey.

It has been suggested that facial traits are informative on the inherited susceptibility to tuberculosis and obesity, two current global health issues. Our aim was to compare the phenotypic characteristics of adolescents with dental markers for a concave (n=420), a convex (n=978), and a straight (n=3542) facial profile in a nationally representative sample of United States adolescents. The results show that adolescents with a concave facial profile, when compared to a straight facial profile, had an increased waist-to-height ratio (Δ, 1.1 [95% CI 0.5-1.7], p<0.003) and an increased acne prevalence (OR, 1.5 [95% CI 1.2-1.9], p<0.001). Adolescents with a convex facial profile, when compared to a straight facial profile, had an increased prevalence of tuberculosis (OR, 4.3 [95% CI 1.4-13.1], p<0.02), increased ectomorphy (Δ, 0.3 [95% CI 0.2-0.4], p<0.0001), increased left-handedness (OR, 1.4 [95% CI 1.1-1.7], p<0.007), increased color-blindness (OR, 1.7 [95% CI 1.3-2.3], p<0.004), and rhesus ee phenotype (OR, 1.3 [95% CI 1.1-1.5], p<0.008). Adolescents with a concave facial profile, when compared to a convex profile, had increased mesomorphy (Δ, 1.3 [95% CI 1.1-1.5], p<0.0001), increased endomorphy (Δ, 0.5 [95% CI 0.4-0.6], p<0.0001), lower ectomorphy (Δ, 0.5 [95% CI 0.4-0.6], p<0.0001), and lower vocabulary test scores (Δ, 2.3 [95% CI 0.8-3.8], p<0.008). It is concluded that population-based survey data confirm that distinct facial features are associated with distinct somatotypes and distinct disease susceptibilities.

Cephalometric analysis and long-term outcomes of orthognathic surgical treatment for obstructive sleep apnoea.

The aim of this study was to describe skeletal and posterior airway changes after orthodontic treatment and surgical jaw advancement, and to evaluate whether there is a correlation between increasing advancement and a long-term reduction in obstructive sleep apnoea (OSA). Lateral cephalograms and polysomnography (apnoea-hypopnoea index, AHI) were collected from patients treated with bilateral sagittal split osteotomy (BSSO) or maxillomandibular advancement (MMA) in combination with orthodontics. Patients completed a questionnaire and the Epworth Sleepiness Scale (ESS) to assess long-term outcomes. Descriptive statistics for cephalometric measurements and linear regression were performed to find estimates of the final OSA (AHI and ESS) as a function of mandibular advancement. Forty-three patients with surgical advancement of the maxilla (5.2mm) and mandible (8.3mm) had a 4-mm increase in posterior airway. Thirty-three patients completed the long-term survey (6.3±2.6 years after treatment); 91% reported a reduction of OSA and were pleased with their facial appearance. The maxillomandibular and posterior airway increased. There was no evidence of a linear relationship between greater amounts of mandibular advancement and improvement of OSA. Patients with less than 10mm advancement had successful objective short-term and subjective long-term OSA reduction.

Detection of post-menopausal women with low bone mineral density and elevated biochemical markers of bone turnover by panoramic radiographs.

OBJECTIVES: The detection of an eroded mandibular cortex on panoramic radiographs and questionnaire-based screening tools show similar diagnostic efficacies for identifying osteoporosis in post-menopausal women. We evaluated whether both tools also have similar diagnostic performances in identifying women with osteoporosis and elevated biochemical markers of bone turnover who have a high risk of fracture. METHODS: Urinary N-telopeptide cross-links of type I collagen (NTx) (corrected for creatinine) and serum levels of total non-bone-specific alkaline phosphatase (ALP) were measured in 99 post-menopausal women aged 44-70 years (mean +/- standard deviation (SD), 54.6 +/- 5.2 years) who underwent bone mineral density (BMD) assessment and panoramic radiography. BMD was measured at the lumbar spine and femoral neck using dual energy X-ray absorptiometry. The Female Osteoporosis Self-assessment Tool for Asia (FOSTA), which is based on age and weight, was used as the questionnaire-based screening tool. Osteoporosis was defined as a BMD T-score of -2.5 or less at either the lumbar spine or the femoral neck. RESULTS: Urinary NTx and serum ALP were significantly associated with cortical erosion, but not with the FOSTA. The areas under the receiver operating characteristics (ROC) curve for identifying participants with osteoporosis were 0.784 for FOSTA and 0.827 for the detection of cortical erosion, and for identifying participants with osteoporosis and elevated urinary NTx they were 0.700 for FOSTA and 0.807 for the detection of cortical erosion. CONCLUSIONS: Our results suggest that panoramic radiography is superior to questionnaire-based screening for identifying women who are at high risk of fracture.

Mercury exposure from dental filling placement during pregnancy and low birth weight risk.

Several European countries have guidelines suggesting that women should not receive mercury-containing dental amalgam fillings during pregnancy. One concern raised by several studies is that mercury exposure during pregnancy may lead to decreased birth weight. A population-based, case-control study was designed to investigate whether placement of mercury-containing fillings in 1993-2000 during pregnancy increased the low-birth-weight risk. Cases and controls were sampled from enrollees of a dental insurance plan with live singleton births in Washington State; 1,117 women with low-birth-weight infants (< 2,500 g) were compared with a random sample of 4,468 women with infants weighing 2,500 g or more. The results indicated that 13% of a dentally insured population had one or more restorative procedures during pregnancy that, regardless of chemical composition, did not increase the low-birth-weight risk (odds ratio = 0.96, 95% confidence interval: 0.88, 1.05). The 4.9% of the women (n = 249) who had at least one mercury-containing amalgam filling during pregnancy were not at an increased risk for a low-birth-weight infant (odds ratio = 0.75, 95% confidence interval: 0.45, 1.26) and neither were women who had 4-11 amalgam fillings placed (odds ratio = 1.00, 95% confidence interval: 0.27, 3.68). This study found no evidence that mercury-containing dental fillings placed during pregnancy increased low-birth-weight risk.

Fractal dimension on dental radiographs.

OBJECTIVES: (1) To compare fractal dimension (FD) from periapical radiographs with FD from panoramic radiographs; (2) to correlate FD with cortical thickness and morphology; and (3) to correlate FD with a reported history of osteoporotic fractures. METHODS: Information on fracture and smoking history was obtained by a telephone interview with 281 elderly (>60 years of age) patients who had periapical and panoramic radiographs exposed on the same date. FD was measured in several locations on both types of radiograph. Mandibular cortical thickness and morphology were obtained from the panoramic radiograph. RESULTS: FD measured in the mandible was lower than FD in the maxilla. Same-jaw measurements had a higher correlation than same-side measurements. FD measured on panoramic radiographs was lower than FD from periapical radiographs. There was a negative correlation between cortical thickness and FD. FD was higher in subjects with more mandibular cortical porosities and resorption. The mean panoramic FD from subjects with a history of osteoporotic fractures was significantly higher, after adjusting for smoking, gender, age, height and weight. CONCLUSIONS: FD measured on panoramic radiographs is lower than FD measured on periapical radiographs. FD is higher in both types of radiograph in subjects with a thinner, severely eroded mandibular cortex and a history of osteoporotic fractures. This study confirms other reports that FD increases when bone mass decreases. In addition, it suggests that panoramic radiographs can be used as a possible alternative for the measurement of FD to periapical radiographs.

Case-control study on self-reported osteoporotic fractures and mandibular cortical bone.

OBJECTIVES: The purpose of this case-control study was to determine whether the radiographic appearance of the mandibular cortical bone in patients who were elderly and noninstitutionalized was related to a self-reported history of osteoporotic fractures. STUDY DESIGN: Patients who had a billing statement at the School of Dentistry dated between 1993 and 1996, who were older than 60, and who had a panoramic radiograph were invited to be interviewed regarding fracture history (circumstances and year of fracture) and risk factors for osteoporosis. Cases (n = 93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n = 394) were individuals reporting traumatic fractures (n = 105) or no fractures (n = 289). Blinded to case-control status, we evaluated the mandibular cortex on a panoramic radiograph and classified them as normal (even and sharp endosteal margin), moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or severely eroded (unequivocal porosity). In addition, cortical thickness was measured below the mental foramen. RESULTS: After adjustment for potentially confounding factors, the odds ratio for an osteoporotic fracture associated with moderately eroded and severely eroded mandibular cortices was 2.0 (95% CI, 1.2 to 3.3) and 8.0 (95% CI, 2.0 to 28.9), respectively. After adjusting for all potentially confounding factors, we found that the cortex was 0.54 mm (or 12%) thinner in subjects with an osteoporotic fracture compared with controls (95% CI, 0.25 to 0.84 mm). CONCLUSIONS: Subjects with a self-reported history of osteoporotic fractures tend to have increased resorption and thinning of the mandibular lower cortex.

A prospective longitudinal study of urinary excretion of a bone resorption marker in adolescents.

In growing subjects, the rates of bone resorption and bone deposition are substantially larger than in non-growing individuals. The purpose of this study was to measure the urinary excretion of a specific bone resorption marker in function of adolescent growth stages in a prospective longitudinal study. A cohort of 60 adolescents (28 male and 32 female) was followed for 3.4 years (range 1.7-4.6 years). Monthly measurements of height, weight and urinary excretion of a bone resorption marker, collagen type I N-telopeptides (NTx), were made. Changes in standing height were used to classify the adolescents into one or more of six adolescent growth stages: pre-pubertal growth (continuous moderate growth rate), ascending growth spurt (increasing growth rate), peak growth spurt (growth rate higher than 7 cm/year for at least 6 months), descending growth spurt (continuous decrease in growth rate), end of growth (growth rate between 0 and 2 cm/year), and no growth. An increase in NTx excretion from the pre-pubertal to peak growth spurt of about 33% was found (44% and 27% for females and males respectively). The decreasing growth rate after the pubertal growth spurt coincided with a clear decrease in NTx excretion. These differences were statistically significant, except between the prepubertal and ascending growth stage. Individual mean NTx excretion during each growth stage was correlated with the individual's growth rate during that time (r = 0.81). There was large inter-and intra individual variability. In non-growing adolescents (growth rate 0 cm/y) NTx excretion levels were 4-7 times greater than in adults. In all females, menarche was followed by a decrease in NTx excretion. In conclusion, the excretion of a specific bone resorption marker, NTx, was correlated with the changes in growth rate during adolescence, both for males and females. There were large inter and intra-individual differences in NTx excretion during the different growth stages. In adolescents who reached their adult height at the end of the pubertal growth spurt. bone resorption decreased dramatically but remained 4-7 fold higher than in adults.

A comparison of sonically derived and traditional cephalometric values.

The roentgenocephalometric technique is the standard used by orthodontists to assess skeletal, dental, and soft-tissue relationships. However, this technique exposes patients to radiation, preventing orthodontists from taking frequent cephalograms to assess growth and to monitor treatment. Recently, the Dolphin Imaging Company developed the DigiGraph, a nonradiographic cephalometric method that uses sound waves and mathematical algorithms, and consequently does not expose patients to radiation. But the DigiGraph's accuracy as a cephalometric alternative has not been adequately investigated. The purpose of this study was to compare the values obtained by traditional cephalometrics with those obtained by the DigiGraph technique for 30 well-known measurements, and then to assess the repeatability (intraobserver comparison) and reproducibility (interobserver comparison) for both techniques. Eighteen of the 30 measurements had mean differences that were statistically significant (p > .0067). Regression plots generally illustrate low correlations for the measurements, although Ricketts' esthetic line (upper and lower lip) and Steiner's soft-tissue convexity reveal strong linear relationships between the two methods. Additionally, the radiographically generated measurements showed greater repeatability and reproducibility.

Longitudinal evaluation of a bone resorption marker in elderly subjects.

The variability over time in the excretion of a bone resorption metabolite (collagen type I N-telopeptide crosslink, NTx) was evaluated in a cohort of community-dwelling elderly men and women (mean age 73 years). Three annual 24-h urine samples were collected. NTx concentration was measured using an established ELISA. Total (24-h) NTx excretion as well as Ntx/creatinine concentration were compared. Men had a significantly lower excretion of NTx/creatinine than women who were not on hormone replacement therapy. Overall, the within-subject long-term coefficient of variability for Ntx/creatinine was 26%. The correlation coefficient between the samples taken a year apart was higher for the 24-h NTx excretion (r = 0.66) than for the 24-h creatinine excretion (r = 0.51). The consistency of NTx excretion over time was also evaluated in all 93 subjects with three yearly samples using Kendall's rank correlation method; the resulting coefficient of concordance was 0.78 (significant at the 0.01 level). These results indicate that while NTx excretion varies in subject samples collected over a period of 2 years, this variability is not much greater than the daily variation reported for NTx and other bone metabolism markers. The relative reproducibility of NTx excretion over time in this age group was also evident in the coefficient of concordance. The results provide support for stratifying subjects according to level of bone resorption and identifying those subjects with high turnover who may be at greater risk of osteoporotic fracture.

Whole body bone resorption in the growing pig.

UNLABELLED: Our knowledge of total body bone resorption during growth is limited. The primary purpose of this study was to determine if a commercially available bone resorption assay, developed for measuring human bone resorption, could be used to measure whole body bone resorption in young, growing pigs. A secondary purpose was to evaluate if this method could detect changes in bone resorption in response to certain dental appliances which have been shown to change mandibular and maxillary growth. Five growing 4-month-old male Hanford minipigs (Sus scrofa) were housed in metabolic cages for 24 h, every other day, over a period of 1 month. Three of the animals were fitted with a mandibular protrusive orthodontic appliance. Total 24 h urines were collected in which the concentration of creatinine and collagen type I N-telopeptide crosslinks (NTx, a marker of bone resorption) were measured. The NTx immunoassay was originally developed for the analysis of human urine. Pig bone was powdered, defatted, and decalcified, and the resulting powder digested with bacterial collagenase. The digest was screened for NTx content, in the same fashion as the pig urines. Bone extract and pig urines were cross-calibrated to a standard of adolescent human urine. This allowed calculation of the daily quantity of pig bone resorbed. Daily metabolite excretion was quite variable in these growing animals; for NTx the CV was 31%, for creatinine the CV was 25%. The mean daily quantities of bone resorption ranged between 26 and 46 grams of bone which amounted to 1.2-1.7% of estimated total skeletal mass. The protrusive appliances increased bone resorption significantly during the first two weeks of the trial. IN CONCLUSION: the NTx assay can be used to measure bone resorption in pigs; the assay is sensitive enough to indicate changes in bone resorption, such as those caused by an orthodontic mandibular protrusive appliance. During growth, bone resorption varies greatly from day to day. On average, every 24 h, 1.4% of the skeletal mass is resorbed.

Detecting osteoporosis using dental radiographs: a comparison of four methods.

The authors evaluated dental radiographs for signs of osteoporosis using four methods: fractal dimension, microdensitometry, pixel intensity and panoramic analysis of cortical thickness. The efficacy of these methods also was compared against three standard bone density measurement techniques used to diagnose osteoporosis in bones other than the jaws: quantitative computed tomography and single- and dual-photon absorptiometry. Pixel intensity was significantly more effective than the other dental methods at distinguishing between radiographs from the osteoporotic group and the control group, although fractal dimension and microdensitometry methods also were effective.

The validity of spot urine samples for low-level occupational mercury exposure assessment and relationship to porphyrin and creatinine excretion rates.

Hg and porphyrin levels in single void urine specimens (spot samples) were compared with calculated 24-hr urine levels in 35 (20 [correction of 25] male and 15 female) practicing dentists who had been occupationally exposed to low levels of elemental Hg. The study aimed to: 1) determine the individual variability for Hg and porphyrin concentrations in spot samples over a 24-hr period; 2) test for the presence of diurnal variation in urinary Hg and porphyrin concentrations; and 3) determine the time of day at which a spot sample would give a Hg concentration closest to the 24-hr average concentration. Results confirmed previous reports of a first-order diurnal pattern with a mid-morning peak for Hg concentration (P < .001). A second-order model best described creatinine excretion (P = .0089), with peaks at about 5:00 and 19:00. The use of creatinine adjustment for Hg concentration significantly reduced the intraindividual variation around the diurnal curve. No diurnal patterns were found for any of the porphyrins examined. We recommend that, for small clinical studies using urinary Hg concentration, 24-hr sampling would be ideal, but that for mass screenings and cross-sectional studies, spot samples may be useful because they correlate fairly well with 24-hr averages (creatinine adjusted, r = 0.61; unadjusted, r = 0.74). Because of the existence of diurnal variation, for all cases using serial sampling attention should be paid to time of day.

Circadian variation in urinary excretion of bone collagen cross-links.

Bone resorption can be evaluated by measuring the urinary excretion of collagen type I cross-linked N telopeptides (NTx). Since it is difficult to obtain (and verify) 24 h urine collections from patients, untimed spot urines are more practical. Such measurements, however, need correction for urine dilution and potentially may vary with collection time since a circadian rhythm in bone metabolism has been reported. This study examined cross-link excretion in urine voids serially collected during a 24 h period from subjects living their normal daily routine (as opposed to a controlled hospital setting). This mimics the situation for walk-in patients visiting a clinician and providing a spot urine. A total of 35 dentists (20 males, 15 females) collected all urine voids separately over a 24 h period. Urines were analyzed for creatinine and NTx. The effects of time of day on the excretion rates of these metabolites (in nmol/h) and on the cross-link:creatinine ratio were assessed. A circadian rhythm was evident in the excretion rate of creatinine with a peak in the late afternoon (18% higher than the 24 h mean, p = 0.0004). The NTx excretion rate peaked in the morning (9% higher than the 24 h mean) but this latter rhythm was not statistically significant (p = 0.31). The NTx:creatinine ratio fell during the day from a high (122% of the 24 h mean) in the early morning to a low in the early evening. This rhythm in the NTx:creatinine ratio in untimed spot urines was statistically significant (p < 0.0001). In conclusion, the NTx:creatinine ratio in spot urines from adult outpatient subjects showed a significant circadian rhythm. Variations in creatinine excretion were the primary cause. Time of day should, therefore, be taken into account when comparing test results of spot urines with normal ranges or with other samples from the same subject.

Bone resorption assessed by immunoassay of urinary cross-linked collagen peptides in patients with osteogenesis imperfecta.

Urinary excretion of type I collagen cross-linked N-telopeptides was studied in 52 children and adolescents with osteogenesis imperfecta (OI) and found to be above the 75th percentile of controls in 44 of the patients. OI patients suffering from fractures during the preceding 6 months had significantly higher values (p < 0.05). In contrast, patients with better motor performance tended to have lower values (p = 0.059). The concentration of urinary type I collagen cross-linked N-telopeptides was positively correlated with urinary calcium excretion (p < 0.05), which was found to be elevated in 20 of the patients. Our results show that during childhood and adolescence in OI not only the synthesis but also the turnover of mature cross-linked type I collagen is disturbed and provide evidence that bone resorption rates are elevated.

Bone resorption rates in children monitored by the urinary assay of collagen type I cross-linked peptides.

When bone is resorbed, cross-linking amino acids from collagen type I (pyridinolines) are excreted in the urine as small peptides. The purpose of this cross-sectional study was to measure the urinary excretion of type I collagen bone degradation products in children and to correlate the results with growth velocity on a population basis. Spot urines from 1076 children and 24 adults were analyzed. The concentrations of cross-linked N-telopeptides of collage type I were measured using a new monoclonal antibody-based microtiter-plate assay, and normalized to creatinine. Age-related changes in cross-link excretion mirrored published standard growth velocity rates for males and females. The correlation coefficient between growth rates and cross-link excretion was 0.91. These results encourage more definitive longitudinal studies where growth rates and collagen cross-link excretion are correlated on an individual-patient basis.

Configurational differences in six skeletal landmarks in surgically treated and nonsurgically treated Class II patients.

Nongrowing patients with full-cusp Class II malocclusions can be treated with or without orthognathic surgery. The purposes of this retrospective study were to observe if skeletal factors influence treatment decisions and to investigate whether a discriminant analysis based on skeletal landmarks can be used to approximate the clinician's decisions. Information was obtained from the records of 44 postmenarchal women with a full-cusp Class II occlusion. Orthognathic surgery was suggested for 23 (52%) of the patients. They were on average 7 years older and presented with a greater maxillomandibular disharmony than the patients treated without surgery. Evaluation of the spatial relationships between the anatomic points by means of multidimensional scaling revealed that the shape of the triangle between articulare, supramentale (point B), and subspinale (point A) differed significantly between groups. For 33 of the 44 patients (75%), the clinician's decisions coincided with a linear discriminant function based on the spatial relationship of subspinale, supramentale, and articulare. These findings suggest that age as well as skeletal configuration played a role in the orthodontist's decision to use surgical or nonsurgical treatment.

Analytical effectiveness calculations concerning the degradation of an inhibitive substrate by a steady-state biofilm.

A reaction engineering model for the degradation of an inhibitory substrate by a steady-state biofilm is presented. The model describes both the metabolic rate controlling behavior of this substrate in the biofilm and the effect of diffusion limitation caused by an arbitrary substrate on the active biofilm thickness. An analytical expression for the biocatalyst effectiveness factor is presented on the basis of Pirt kinetics for cell maintenance, first order substrate inhibition kinetics, and zero order substrate consumption kinetics. The proposed expression for the biocatalyst effectiveness factor is much more convenient to incorporate into a macroreactor model than the numerical alternatives. Simple criteria are presented to check the applicability of the model in case of true Monod kinetics. The analytical solution is expected to be particularly applicable to processes where a low soluble organic substrate controls the biomass growth, a situation which is often met in wastewater purification processes of industrial importance. The degradation of phenol by Pseudomonas sp. is treated as an example.