Lingual nerve injury II. Observations on sensory recovery after micro-neurosurgical reconstruction.

The aim of this study was to report on neurosensory recovery after micro-surgical lingual nerve repair, and to evaluate the effect on recovery of age, delay in repair and gender of the patient. Seventy-four patients entered the study. The micro-surgical repair performed was direct nerve suture (n=71), external neurolysis (n=2) and excision of neuroma without nerve coaptation (n=1). A standardized neurosensory examination was employed in all patients before surgery and during follow up. Recovery was significant for perception of all tested stimuli: feather light touch, pin prick, pointed/dull discrimination, warm, cold, location of touch, and brush stroke direction, pain perception and two-point discrimination. The rate of recovery was highest during the first 6 months. Females were more often affected than males, but recovery was not influenced by gender. The distribution of neurogenic discomfort (paraesthesia, etc.) remained essentially unchanged. Disregarding cases with poor recovery, delay of surgery had a small but significant influence on the regain of neurosensory function of the lingual nerve whereas age had no such effect. None of the patients recovered to normal. Lingual nerve injury seriously affects the quality of life of patients, and micro-surgical repair is beneficial in the absence of spontaneous recovery.

Lingual nerve injury in third molar surgery I. Observations on recovery of sensation with spontaneous healing.

The aim of this study was to investigate the healing potential of damaged lingual nerves with some remaining function at least 3 months post injury. Forty-six patients were monitored at different time intervals after injury. A simple neurosensory examination included the perception of tactile, thermal stimuli and location of stimulus, as well as two-point discrimination, pain and the presence of a neuroma at the lesion site. Neurogenic signs and symptoms related to the injury and their variation over time were registered. Females were more often referred than males. Most lingual nerve injuries exhibited a significant potential for recovery, but only a few patients made a full recovery with absence of neurogenic symptoms. The recovery rate was highest during the first 6 months. Recovery was not influenced by gender, and only slightly by age. The presence of a neuroma was associated with a more severe injury. Patients should be monitored repeatedly for at least 3 months, and not operated on until neurosensory function no longer improves, and is less than what might be rendered by microsurgical repair. Through proper training and mastery of the surgical approach, every effort should be focused on sparing the lingual nerve, considering its proximity to the field of surgery.

Oral premalignant lesions: is a biopsy reliable?

PURPOSE: The purpose of the present retrospective study was to learn whether a biopsy of oral premalignant lesions, leukoplakia and erythroplakia, shows histopathological findings representative of the whole surgically removed lesion. Moreover, to see whether histopathological characteristics of the whole lesion are significant for future malignant development after surgery. MATERIALS AND METHODS: A total of 101 lesions in 96 patients were included, 42 lesions (41%) being homogenous and 50 (50%) non-homogenous leukoplakias, whereas nine (9%) were erythroplakias. The lesions were biopsied and subsequently surgically removed on the average of 10.4 months after biopsy. Surgical specimens were examined in two or more step sections distributed throughout the specimen. The histological findings of the biopsies were compared with those of the whole lesions. After surgical intervention the patients were followed (mean 6.8 years, range: 1.5-18.6), and new biopsies taken in case of recurrences. Smokers (73%) were encouraged to quit smoking and candidal infections were treated. The possible influence of different variables on the risk of malignant development was estimated by means of logistic regression analysis. RESULTS: Histological examination of the whole lesions showed that seven lesions (7%) harboured a carcinoma and 70 lesions (69%) showed a degree of epithelial dysplasia or carcinoma in situ. Eleven lesions (12%) developed carcinoma after a mean follow-up period of 7.5 years. A comparison of the degree of dysplasia in the biopsies with that of the whole lesion demonstrated variation with concurrent diagnosis in 49% of the lesions and in 79% after inclusion of lesions with one degree up or down the scale of epithelial dysplasia. CONCLUSION: The estimated odds ratio showed that none of the associated variables including presence of any degree of epithelial dysplasia in the whole lesion, site, demarcation and smoking had influence on the risk of malignant development.

A method for assessment of quality of life in relation to prosthodontics. Partial edentulism and removable partial dentures.

The aim of this study was to evaluate the possible use in prosthodontics of a method for an interview technique allowing maximal individuality within the cultural boundaries. The impact of partial edentulism and removable partial denture (RPD) wearing on quality of life was chosen as the target question. The interview included patient generated selection of five quality of life cues. The current status/intensity of each cue was measured by use of a Visual Analogue Scale (VAS), the relative weight/importance between the cues by a direct-weighting (DW) instrument, and a summarized quality of life score was calculated. One hundred and one participants with partial edentulism with or without RPDs were included in the study. No correlation was found between the VAS- and DW-scores, indicating that different aspects are measured with these two instruments. Sixty to seventy per cent of the participants answered positively to questions about the test method, including self-knowledge, consciousness and identification of needs and wishes. The 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting' turned out to be a useful instrument for assessing patients' priorities, and fulfils in many ways the demands for individualized problem identification, decision-making and treatment planning. The results of the comparison of RPD wearers and non-RPD wearers showed that aesthetics is a major factor and that the overall quality of life between the experienced RPD wearers and non-RPD wearers in this study did not differ significantly.

Dentine-bonded resin composite (Retroplast) for root-end filling: a prospective clinical and radiographic study with a mean follow-up period of 8 years.

AIM: To evaluate treatment outcome after using a resin composite (Retroplast, RP) in combination with a dentine-bonding agent (GLUMA) as root-end filling material after 1 year as well as after more than 5 years (final examination). Also, the influence of various pre-, intra- and postoperative factors on the treatment outcome was studied. METHODOLOGY: All patients (87) undergoing root-end resection consecutively treated by root-end filling with RP on an incisor, canine, pre-molar, or first molar (87 teeth, 118 roots) were initially enrolled in the study. RP was applied on the entire resected surface that was prepared to a slightly concave shape and after conditioning with EDTA and GLUMA. The treatment outcome involving subjective, clinical and radiographic parameters was evaluated after 1 year and at the final examination. A total of 27 patients (36 roots) were excluded from the study because of unavailability of follow-up (19) and extraction of the operated tooth for reasons other than failed surgery (8). Consequently, 60 patients (82 roots) were included in the final material. The mean follow-up period at the final examination was 8 years (range: 6.5-9 years). RESULTS: The radiographic evaluation at the final examination revealed that 77%, 5%, 7% and 11% of the treated roots were characterized by complete, incomplete, uncertain and unsatisfactory healing, respectively. A total of 95% of the roots classified as completely healed at the 1-year control were also completely healed at the final examination. Two roots (5%) showing complete healing at the 1-year control revealed unsatisfactory healing at the final examination because of displaced or lost RP-filling. Moreover, 60% of the roots with uncertain healing at the 1-year control demonstrated complete or incomplete healing at the final examination. The classification according to subjective, clinical and radiographic parameters revealed that 78% of the teeth were characterized by a successful treatment outcome at the final examination. Evaluation of the influence of various pre-, intra- and postoperative factors on the treatment outcome revealed that the radiographic classification at the final examination was exclusively influenced by the radiographic classification at the 1-year control (P < 0.001). CONCLUSIONS: The present long-term study indicates that RP can be used for root-end filling with a successful treatment outcome.

Is pre-term labour associated with periodontitis in a Danish maternity ward?

OBJECTIVES: To reveal differences in periodontal status and presence of subgingival bacteria in a Scandinavian population of women with pre-term birth compared with women who delivered at term. MATERIALS AND METHODS: Twenty-one women with pre-term labour (before week 35) and 33 women with term labour (between weeks 38 and 41) were included in this case-control study. Periodontal measurements included plaque index (PlI), probing pocket depth (PPD) and bleeding on probing (BOP). Inter-proximal distances from the cemento-enamel junction (CEJ) to the marginal bone crest (MBC) were measured on bitewing radiographs. In 31 patients (16 cases and 15 controls) the subgingival plaque was analysed using "checkerboard" DNA-DNA hybridization. RESULTS: Differences between the two examined groups were found related to "Twin births" (p=0.0064) and "Smokers" (p=0.03). None of the periodontal measurements showed any association. Significant differences were found concerning presence of Tannerella forsythensis, Treponema denticola, Peptostreptococcus micros, Streptococcus intermedius, Streptococcus oralis, Streptococcus sanguis and Capnocytophaga ochracea but when defining sites with >10(5) bacteria as heavily colonized, no statistical difference was found between the two groups. CONCLUSION: A relation between pre-term birth and periodontitis was not revealed in the present study.

Long-term treatment outcome of oral premalignant lesions.

The purpose of the present retrospective study was to learn the long-term outcome of oral premalignant lesions, leukoplakia and erythroplakia, with or without surgical intervention and to relate the outcome to factors supposed to be significant for malignant development including clinical type, demarcation, size, site, presence of epithelial dysplasia, smoking and surgery. A total of 269 lesions in 236 patients were included. Ninety-four lesions were surgically removed, 39 lesions (41%) being homogenous and 46 (49%) non-homogenous leukoplakias whereas nine (5%) were erythroplakias. Seventy-three percent of the lesions were associated with tobacco habits. The mean size of the lesions was 486 mm(2), and 71% of the lesions showed a degree of epithelial dysplasia. After excision the defects were closed primarily by transposition of mucosal flaps or they were covered by free mucosal or skin grafts. A few defects were left for secondary healing. After surgical treatment the patients were followed (mean 6.8 yrs, range 1.5-18.6 yrs), and new biopsies taken in case of recurrences. One hundred and seventy five lesions had no surgical intervention, 149 lesions (85%) being homogenous and 20 (11%) non-homogenous leukoplakias, and 6 (3%) erythroplakias. Eighty-one percent of the lesions were associated with smoking. The mean size of the lesions was 503 mm(2) and 21 of the lesions (12%) exhibited epithelial dysplasia. Sixty-five lesions were not biopsied. These patients were also followed (mean 5.5 yrs, range 1.1-20.2 yrs), and biopsies taken in case of changes indicative of malignant development. All patients were encouraged to quit smoking and candidal infections were treated. The possible role of different variables for malignant development was estimated by means of logistic regression analysis. Following surgical treatment 11 lesions (12%) developed carcinoma after a mean follow-up period of 7.5 yrs. Non-homogenous leukoplakia accounted for the highest frequency of malignant development, i.e. 20%, whereas 3% of the homogenous leukoplakias developed carcinomas. Surgically treated lesions with slight, moderate, severe and no epithelial dysplasia developed carcinoma with similar frequencies, i.e. 9-11%. Without surgical intervention 16% of the 175 lesions disappeared whereas seven lesions (4%) developed carcinoma after a mean observation period of 6.6 yrs. The highest frequency of malignant development (15%) was seen for non-homogenous leukoplakias, this figure being 3% for homogenous leukoplakias. Fourteen percent of lesions with slight epithelial dysplasia developed malignancy and 2% of lesions with no dysplasia showed malignant transformation. Logistic regression analysis showed a seven times increased risk (OR = 7.0) of non-homogenous leukoplakia for malignant development as compared with homogenous leukoplakia and a 5.4 times increased risk for malignant development for lesions with a size exceeding 200 mm(2). No other examined variables including presence of any degree of epithelial dysplasia, site, demarcation, smoking and surgical intervention were statistically significant factors for malignant development.

The effect of spironolactone on experimental periodontitis in rats.

BACKGROUND: Elevated levels of tumour necrosis factor (TNF) have been found in patients with adult periodontitis. Animal studies have shown that TNF plays an important role in the pathogenesis of periodontitis. New findings suggest that the aldosterone-inhibitor spironolactone possesses an anti-TNF effect. The purpose of the study was to determine the anti-TNF effect of spironolactone in an endotoxic shock rat model and to disclose the effect of oral administration of spironolactone on the development of experimental periodontitis in rats. METHODS: The study was divided in two parts. Part 1: oral administration of spironolactone (100 mg/kg) followed by intravenous lipopolysaccharide (1 mg/kg) infusion 45 min later. Blood samples were taken before and 90 min after lipopolysaccharide infusion to determine the TNF levels in spironolactone treated and non-treated rats. Part 2: oral administration of spironolactone [100 mg/(kg day)] starting 2 days prior to induction of experimental periodontitis established by peridental ligatures. Morphometrical and radiographical registrations of alveolar bone destruction were carried out to determine the effect of spironolactone on the progression of experimental periodontitis. RESULTS: In part 1 the endotoxic shock model showed a significant reduction in TNF levels in the spironolactone-treated group compared to the non-treated group, suggesting that spironolactone acts as a TNF inhibitor. In part 2 spironolactone-treated rats did not demonstrate significantly less alveolar bone destruction compared to non-treated rats. CONCLUSIONS: The insignificant effect of spironolactone treatment could be explained by the fast metabolism of spironolactone and that spironolactone does not completely inhibit TNF production in rats. Moreover, many other cytokines and mediators involved in alveolar bone destruction may account for the lacking response to spironolactone.

Masticatory and nutritional aspects on fixed and removable partial dentures.

The aim of the present study was to evaluate mastication, food selection and nutritional aspects in two groups of persons restored with fixed (FPD, N=44) and removable (RPD, N=40) partial dentures respectively. The subjects were part of a cohort study of 67-68-year-old men living in Malmö, Sweden. The two groups were very similar regarding social factors and the inclusion criteria were chosen so that the groups were very equal regarding oral factors, apart from the difference in fixed and removable partial dentures. The number of natural teeth, number of replaced teeth and occlusal contacts did not differ significantly between the two groups, nor did the distribution of maxillary and mandibular dentures. A comprehensive examination of several general health factors included a home interview of dietary habits. A clinical examination included a 20-minute oral examination with registration of number of teeth, FPDs, RPDs, and occlusal contacts. It also included masticatory tests: chewing gum colour mixing, chewing gum bolus shaping, and swallowing threshold (number of strokes to the first swallow of an almond). The consumption of hard and soft foods was revealed by the dietary interview as well as the intake of energy and some nutrients. There was a significant difference between the groups regarding the capacity to mix the two-coloured chewing gum, to shape the chewing gum bolus and in the consumption of hard foods. There was no difference in the swallowing threshold and the consumption of soft foods. The intake of energy and nutrients did not differ significantly between the groups. The differences in masticatory capacity found thus seem to have little, if any, effect on the factors of importance for general health. A reasonable explanation for the differences found is that artificial teeth that are well retained, such as FPDs, make more active chewing possible than do removable, and often somewhat loose-fitting partial dentures.

The prenatal development of the human cerebellar field in Down syndrome.

OBJECTIVES: To describe the development of the osseous field enclosing the cerebellum and part of the brain stem (the neuro-osteological cerebellar field) in Down syndrome, and compare the development with normal developmental standard of the field. DESIGN: Radiographic, cephalometric and histologic examination of 58 legally or spontaneously aborted Down syndrome prenatal human fetuses; crown-rump length of 80-255 mm and approximate gestational age from 13 to 26 weeks. RESULTS: The growth of the Down syndrome cerebellar field is smaller in the sagittal and vertical directions than in normal fetuses. CONCLUSION: In the present study the pathological development of the cerebellar field was described in a genotypic sample. In combining normal and pathological development of neural and osseous tissues a better understanding of the genotype/phenotype interactions is attainable and fields of common gene expression maybe defined.

The pre-natal development and osseous growth of the human cerebellar field.

OBJECTIVES: To describe the pre-natal development of the bones that enclose the cerebellum and part of the brain stem (the neuro-osteological cerebellar field) in the mid-sagittal plane. DESIGN: Radiographic, cephalometric and histologic examination of normal pre-natal human fetuses; 50 normal fetuses, with crown-rump length of 18-227 mm and approximate gestational age from 6 to 26 weeks. RESULTS: The cerebellar field expressed extensive growth during development both sagittally and vertically. Because of changes in shape, the field was displaced in an anterio-caudal direction. CONCLUSION: In the present study we recorded normal measurements of size, shape and position of the cerebellar field. These standards can be used as references in skeletal analysis of cases with cranial abnormalities and cerebellar malformations.

Effect of Gyrodactylus derjavini infections on cortisol production in rainbow trout fry.

Cortisol production in fry of rainbow trout (367-456 mg body weight) infected with the ectoparasitic monogenean Gyrodactylus derjavini (mean intensities 4.7 and 4.9 parasites per fish) was studied at two temperature levels, 4-6 degrees C and 11-12 degrees C, respectively. Due to difficulties in obtaining an adequate amount of plasma from the small sized fish, the corticosteroid concentration was measured in the body fluid recovered (as supernatant) after sonication and centrifugation of whole fry. Infected fry at 11-12 degrees C showed an elevated level of cortisol compared to uninfected fry. However, the cortisol concentration was lower than in fish exposed to handling stress. At 4 degrees C, the cortisol level in infected fish compared to uninfected was insignificantly increased. The findings are discussed in relation to the role of monogeneans as inducers of secondary infections.

A clinical index for evaluating and monitoring dental erosion.

This study describes a new fine-scaled system for classifying initial and advanced dental erosions. The system includes the use of study casts of the teeth in an epoxy resin with an accurate surface reproduction. The severity of erosion on each tooth surface is scored according to six grades of severity. In addition, the presence of a Class V restoration and dental erosion on the same surface increases the erosion score, as it is assumed that the need for restorative treatment can be caused by the erosion. A high inter-examiner agreement was found when the present scoring system was used by two examiners on the same sample. With this prerequisite it is proposed that an index value for facial, oral, incisal/occlusal and cervical surfaces is calculated as the mean value of scores for the respective surfaces. The index values represent the severity of tooth substance loss in various locations of the oral cavity and are furthermore suitable for data analysis. The system is thereby well-suited for determining etiologic factors and monitoring the progression of erosion over time.

Dissolution of type I collagen fibrils by gingival fibroblasts isolated from patients of various periodontitis categories.

The classification of periodontitis in various disease categories, including juvenile periodontitis, rapidly progressive adult periodontitis and slowly progressive adult periodontitis is based mainly on differences in disease progression and age group susceptibility. Because dissolution of collagen fibers is an integral part of periodontal attachment loss, we investigated whether the clinical differences among these periodontitis/control groups are reflected in the collagen-degrading activity of gingival fibroblasts isolated from affected tissues. All fibroblast strains isolated from the 4 groups (n = 48) displayed cell-associated collagenolytic activity when seeded in contact with a reconstituted film of type I collagen fibrils. Cells from the control group (n = 14) dissolved the collagen fibril film twice as fast as those from each of the 3 disease groups (juvenile periodontitis (n = 13), rapidly progressive adult periodontitis (n = 7), and slowly progressive adult periodontitis (n = 14)). Both interleukin-1 beta and phorbolester accelerated the rate of dissolution 2-4-fold, but even after cytokine or phorbolester stimulation control cells were still considerably more effective in dissolving the collagen fibrils than cells from the disease groups. The observation made in this study, that dissolution of collagen fibrils by gingival fibroblasts from periodontally diseased individuals is significantly slower than by cells from healthy control subjects, challenges disease paradigms based on a direct relationship between collagenolytic potential and disease activity.

Accuracy of radiographic diagnosis of peri-implant radiolucencies--an in vitro experiment.

The absence of a peri-implant radiolucency on radiographs is used as a criterion for implant success. The purpose of the present study was to evaluate the accuracy of diagnosing peri-implant radiolucencies using an experimental model. Astra Tech fixtures were inserted into 20 bony specimens. Later, the fixtures were removed and the prepared cavities were enlarged in 2 steps. The specimens were radiographed under strictly standardized circumstances in the 3 stages ("press-fit" = simulated osseointegration, and "0.1 mm space" and "0.175 mm space" = simulated connective tissue layer). All specimens were radiographed with 2 vertical angulations (0 degree and 15 degrees). Ten observers read the radiographs and evaluated bone-implant relationship on a 5-point scale. The interobserver agreement was low. Specificity was remarkably low, and sensitivity was moderate. A significant difference in diagnostic accuracy was found for 0.175 mm peri-implant-space compared to 0.1 mm space. The diagnostic accuracy was found to be highest for 0.175 mm peri-implant space specimens. It is concluded, that radiography seems to be an unreliable method for diagnosing peri-implant spaces, although accuracy improved at increasing space widths. Strict orthogonal projection angles did not improve diagnostic accuracy.

Marginal bone level after Le Fort I osteotomy.

The object of the study was to assess the effect of Le Fort I osteotomy and maxillary interdental osteotomy on the marginal bone level. Forty patients (25 female, 15 male, mean age 24 years, range 15-46) treated for dentofacial deformities comprised the subjects of the study and underwent Le Fort I osteotomy with or without simultaneous interdental osteotomy. Outcome was measured by marginal bone level measured in radiographs before and 1 year after operation. All patients had good oral hygiene. There was an overall significant mean marginal bone loss of 0.2 mm at surfaces without interdental osteotomy (P = 0.001). When the bone loss of the different types of teeth was considered separately, only those of central incisors (0.5 mm, P = 0.0001) and canines (0.4 mm, P = 0.004) were significant. Interdental osteotomy caused an overall mean marginal bone loss of 0.4 mm, but this was not significantly different from that of teeth without interdental osteotomy (P = 0.07). When the bone loss of different types of teeth after interdental osteotomy was considered separately, the only difference that achieved significance was that of premolars (0.3 mm, P = 0.04). Though there were significant differences, none of them was large enough to have any clinical relevance. Le Fort I osteotomy and interdental osteotomy may only in a few instances cause marginal bone loss of clinical relevance. However, the present study was performed on patients with good oral hygiene. The above conclusions may therefore not be valid for patients who, prior to surgery, already have a compromised marginal bone level.

Influence of conventional forceps extraction and extraction with an extrusion instrument on cementoblast loss and external root resorption of replanted monkey incisors.

Cementoblast loss and root resorption on the root surface was registered histologically after removal and immediate replantation of maxillary central incisors in monkeys (Cecropithecus aethiops). Incisors were removed with either a conventional extraction technique using forceps or with a special designed extrusion instrument and in both cases teeth were immediately replanted. Altogether 18 monkeys were used for the experiments in which 9 monkeys were sacrificed after 3 d and 9 animals after 8 wk. Histological analysis was made in horizontal sections perpendicular to the long axis of the tooth using either 24 measuring points or 12 sections. Histometric analysis showed extensive cementoblast loss in the periodontal ligament (PDL) and with a maximum of damage occurring on the corner surfaces of the root. Extracted teeth showed significantly more extensive cementoblast loss than extruded teeth. Root resorption was also found in the corner locations and was significantly more frequent in extracted than in extruded teeth. There was a similarity in the distribution of cementoblast loss and root resorption indicating that root resorption develops in the same areas where cementoblast loss takes place, i.e. locations that are more compressed during removal of the tooth and must have caused by mechanical damage to the PDL exerted on the root surface during tooth removal.

Elimination of Elyzol 25% Dentalgel matrix from periodontal pockets.

Elyzo 25% Dentalgel (EDG) which is developed for use in the treatment of periodontitis is a suspension of metronidazole benzoate (40%) in a mixture of glyceryl mono-oleate (GMO) and triglyceride (sesame oil). Metronidazole can be detected in the periodontal pockets 24-36 h after application. The aim of the present study was to estimate the period of time that the gel matrix persists on periodontal pockets after 1 application of EDG. 12 patients were included in the study. From each patient, 1 sample was taken before and immediately after, and 1, 2, 3, 4, 5, 6, 8, 12 and 24 h after application. Subgingival scaling followed by absorption of gingival crevicular fluid with filter paper was used for sampling. The sampling unit was 1 tooth. Each sample was assayed for the amount of GMO and oleic acid (a degradation product of GMO) by means of high-performance liquid chromatography (HPLC) with UV detection. To allow determination of the GMO dose applied into the pockets and to estimate the recovery rate of the sampling method, 1 tooth in each patient was selected for sampling as soon as the gel had set, i.e., about 10 min after application. Only in 1 patient was a detectable amount of GMO within the pocket revealed 24 h after application. This amount was approximately 0.5% of the mean GMO dose applied around 1 tooth. GMO was found no longer than 12 h in the remaining patients.

Oral candidiasis and immune status of HIV-infected patients.

A total of 84 HIV-infected homosexual men having either normal oral mucosa (NOM), erythematous candidiasis (EC) or pseudomembranous candidiasis (PsC) were included in the study. The patients were evaluated by median number of peripheral CD4+ cells, CD8+ cells and by lymphocyte function assessed by poke-weed mitogen test. There was a significant difference between CD4+ counts among patients with the two subtypes of candidiasis (95% CI of median difference: 10-240/mm3; P = 0.03), but not for pokeweed mitogen response. Survival analysis showed that after 2 y there was no significant difference in development of AIDS between patients with EC and PsC (P = 0.29). If patients with both types of oral candidiasis were pooled and compared with patients with NOM, a significant difference in development of AIDS was found (P = 0.04). It is concluded that HIV-infected patients with oral candidiasis of any subtype (EC or PsC) are significantly more immune suppressed and show a faster development of AIDS than HIV-infected patients with NOM. However, in this cohort, EC and PsC are of equal importance as predictors for immune suppression and AIDS development.

Comparison of a manual and a new electric toothbrush for controlling plaque and gingivitis.

In the present clinical trial, the effect on existing plaque and gingivitis of a new electric toothbrush (ET) was compared to that of a manual toothbrush (MT). 40 medical students, age 18-30 years, participated. Plaque index (PlI) and gingival index (GI) were recorded at 6 sites at all teeth. At baseline, a PlI and GI > 1 were required. The participants were at random allocated to a group using either ET or MT and were instructed only to use the assigned toothbrush, brushing each morning and evening for 2 min. No oral hygiene instruction was given. Re-examination was done after 1, 2 and 6 weeks. In the MT group, a minor decrease in mean PlI was found after 6 weeks (all sites: from 1.2 to 1.1, approximal sites: from 1.4 to 1.2). The corresponding figures in the ET group were: 1.2 to 0.6 and 1.4 to 0.8. After 6 weeks, the % of sites with visible plaque with MT was: 24% (all sites) and 30% (approximal sites) and with ET 8% and 9%, respectively. With MT, mean GI was unchanged after 6 weeks compared to baseline, whereas with ET, the changes were from 1.1 to 0.9 (all sites) and from 1.1 to 1.0 (approximal sites). The % of sites with GI score > or = 2 had not changed after 6 weeks with MT (all sites: 11%, approximal sites: 13%). With ET, these results were 3% and 4%, respectively.