Risk assessment strategies for early detection and prediction of infectious disease outbreaks associated with climate change.

A new generation of surveillance strategies is being developed to help detect emerging infections and to identify the increased risks of infectious disease outbreaks that are expected to occur with climate change. These surveillance strategies include event-based surveillance (EBS) systems and risk modelling. The EBS systems use open-source internet data, such as media reports, official reports, and social media (such as Twitter) to detect evidence of an emerging threat, and can be used in conjunction with conventional surveillance systems to enhance early warning of public health threats. More recently, EBS systems include artificial intelligence applications such machine learning and natural language processing to increase the speed, capacity and accuracy of filtering, classifying and analysing health-related internet data. Risk modelling uses statistical and mathematical methods to assess the severity of disease emergence and spread given factors about the host (e.g. number of reported cases), pathogen (e.g. pathogenicity) and environment (e.g. climate suitability for reservoir populations). The types of data in these models are expanding to include health-related information from open-source internet data and information on mobility patterns of humans and goods. This information is helping to identify susceptible populations and predict the pathways from which infections might spread into new areas and new countries. As a powerful addition to traditional surveillance strategies that identify what has already happened, it is anticipated that EBS systems and risk modelling will increasingly be used to inform public health actions to prevent, detect and mitigate the climate change increases in infectious diseases.

Effect of clinical guidelines on practice for extraction of lower third molars: study of referrals in 1997 and 2000.

We made a retrospective study of patient records for 3-month periods during 1997 and 2000 to assess changes in referral patterns and decision-making for extraction of lower third molars after publication of national guidelines. A total of 277 patients were referred to the department for extraction of lower third molars in 1997 and 234 in 2000 while overall referrals increased from 884 to 979. The number having extractions dropped from 243/277 (88%) to 190/234 (81%) of those referred (P=0.05) and of those operated on, bilateral removal dropped from 120/243 (49%) to 65/190 (34%) (P=0.002). The number of patients operated on under general anaesthesia reduced from 161/243 (66%) to 103/190 (54%) (P=0.01). However, women remained more likely to get treatment under general anaesthesia than men. In conclusion, there was a reduction in referrals for extraction of third molars, the proportion of referred patients having extractions, the number of bilateral operations, and changes in the choice of anaesthesia over the period of introduction of national guidelines on operations for third molars.

Decreasing p53 overexpression in sequential, recurrent, oral squamous cell carcinomas.

Expression of abnormal p53 protein is a widely recognised marker of malignancy including oral squamous cell carcinoma. This is a longitudinal study of p53 expression in fixed, paraffin-embedded tissue from 3 patients with multiple, recurrent, squamous cell carcinomas of floor of mouth (n = 4, 4, 3). All carcinomas demonstrated increased expression of p53 compared to normal tissues. However, there was reduction in expression from primaries to subsequent recurrent tumours in all 3 patients. The significance of reduction of expression of p53 in sequential recurrences is unclear, but as each of these patients has now survived for at least 5 years this may be a phenomenon indicating a favourable prognosis. As this study relates to only 3 patients, a larger study is needed to confirm this initial observation.

Generalized joint hypermobility as a factor in clicking of the temporomandibular joint.

Twenty-six patients with clicking or locking of the temporomandibular joint (TMJ) and 28 age- and sex-matched controls were assessed for generalized joint hypermobility by BEIGHTON's method. Function of the masticatory apparatus was measured with FRICTON's Craniomandibular Index. The TMJ patients had significantly higher joint mobility scores, but within the patient group there was no correlation between either the dysfunction or palpation scores and the hypermobility scores. The findings are interpreted as supporting multiple causes of TMJ internal derangement, one of which is a systemic joint factor.

The polymorphous odontogenic cyst.

Over the years there have been sporadic reports of unusual cystic lesions of the jaws, not readily classified under conventional headings but which have been variously diagnosed as median-mandibular, glandular, sialo-odontogenic or botryoid odontogenic cyst. We present five cases which do not fit into other categories of odontogenic cyst, two of which have recurred within a few years of conservative treatment. This paper aims to alert clinicians to the propensity for regrowth of these cysts, proposes the term polymorphous odontogenic cyst for these lesions, to encompass their varied histological appearances and discusses their distinction from other cyst types with mucous and papillary formations in epithelium.

Mandibular infected buccal cyst or a paradental cyst?: Report of a case.

The mandibular infected buccal cyst occurs on the buccal and distal aspects of the roots of the partially or newly erupted first permanent molar. It typically affects children between the ages of 6 to 10 years and the associated first permanent molar is vital. The cyst is lined with a non-keratinised squamous epithelium with inflammatory cell infiltrate in the connective tissue. Most clinical and histological features are similar to those reported for paradental cysts.

Maxillofacial surgery should become a specialty of medicine.

The British Association of Oral and Maxillofacial Surgeons and the Royal Colleges have rightly responded over the years to pressures within, and outside dentistry for higher levels of training in oral and maxillofacial surgery. There has been adoption of a series of qualification as, at first desirable, then mandatory for a trainee to be considered suitable to hold the rank of consultant. Over the last 20 years there has been a concomitant change in both the title held by consultants in our field, and the range of work they have expected, and been expected to undertake. I believe that although each individual step in these processes is understandable, and seems sensible, the overall effect is not as beneficial as had been hoped. Further, as the process seems to be continuing and possibly accelerating, the time has come to reevaluate the relationship of maxillofacial surgery to dentistry and the form of training best suited to producing maxillofacial surgeons.

Cephradine penetration of mandibular bone.

The concentration of cephradine in serum and mandibular bone was assayed in 22 patients undergoing third molar surgery following a single 1-g intramuscular injection. Serum and cortical bone samples taken simultaneously contained mean cephradine concentrations of 12.41 micrograms/mL and 1.25 micrograms/g, respectively. These results, when compared with those reported for other bony sites, including femoral head and knee, show a reduced bone penetration with a bone-to-serum ratio of approximately 0.10:1.

Differential diagnosis and surgical management of parapharyngeal masses: review and an unusual illustrative case.

Diagnosis and management of swellings of the parapharyngeal space are difficult because of the inaccessibility of the region, which contains part of the parotid gland with major vascular and neural structures that may be subject to disease. An unusual case of a spherical mass with a calcified margin within the parapharyngeal space is presented; it illustrates an approach to diagnosis and management.

Histological localization of myxoid tissue in normal human palatal mucosa and its glycosaminoglycans.

Eighteen specimens of palatal mucosa were taken from 17 human subjects. Paraffin-wax sections were stained by routine methods and with various techniques to demonstrate glycosaminoglycans (GAG). In some sections, GAG were removed by selective degradative procedures before staining. Beneath all rugae, there were myxoid areas varying in size and marginal definition. Collagen fibres were few; elastic and reticulin fibres were numerous in a minority of sections. Alcianophilia at pH 2.5, preventable by streptomyces hyaluronidase digestion, suggested the presence of hyaluronic acid beneath the rugae. Alcian-blue staining at pH 1.0 and with the critical electrolyte concentration method using 0.5 M MgCl2 did not distinguish the myxoid tissue from the surrounding connective tissue and could be prevented by digestion with testicular hyaluronidase or chondroitinase ABC. Chondroitin sulphate and, or dermatan sulphate thus may be present but were not localized to the myxoid tissue. This unusual zone of loose connective tissue may act as a physical buffer resisting the local effects of high loads by allowing reversible extrusion of the water.

Healing following full thickness excision of human palatal mucosa.

Healing was observed for 6 months following excision of full thickness normal adult human palatal mucosa (approx 12 mm X 10 mm) to measure the degree of wound contraction and determine if rugae would regenerate. Measurements of plaster models showed stretching and displacement of soft tissue not involved in the original would toward the centre of the wound from 6 weeks postoperatively. The distance between the incisive papilla and the most posterior ruga on the side of operation reduced by 2.2 mm and the first ruga on the opposite side was stretched in length by 0.9 mm. A fragment of superficial bone (approx 10 mm X 7 mm) sequestrated at 5 weeks, epithelialisation was complete by 8 weeks but the rugae did not reform at all.

Biochemistry of glycosaminoglycans in the skin and oral mucosa of the rat.

Glycosaminoglycans (GAG) were extracted by digestion with papain followed by ultrafiltration and separated by cellulose-acetate electrophoresis and by chromatography of their cetyl-pyridinium complexes on cellulose microcolumns. The uronic-acid content of the tissues ranged from 0.8 to 2.4 mg/g of dry defatted tissue. Hyaluronic acid and dermatan sulphate were found in all tissues with chondroitin-4-sulphate also in skin, palatal mucosa and gingiva. There was 3-fold more hyaluronic acid in palatal mucosa than in any other tissue; it was concentrated in the antemolar rugae. A substance of presumptive salivary origin staining with alcian blue was found in cheek and floor of mouth mucosa. It migrated differently from reference GAG by electrophoresis and was not degraded by testicular hyaluronidase.