Malocclusion traits and oral health-related quality of life in Finnish adults.

AIM: The aim of this study was to examine the association of increased overjet, cross-bite/scissor-bite and increased overbite/open bite with oral health-related quality of life (OHRQoL) among Finnish adults using nationally representative data. METHODS: Part of the data from the Health 2000 Survey, Finland, was used in this study. A total of 4711 people were included, representing adults aged ≥30 years. The outcome variable was OHRQoL severity which was measured using the 14-item Oral Health Impact Profile (OHIP-14). Three malocclusion traits (increased overjet, cross-bite/scissor-bite and increased overbite/open bite) were used as explanatory variables. Age group, marital status, education level, income, employment status, having at least one decayed tooth or periodontal pocket ≥6 mm, the number of contacting pairs of teeth, denture status and self-reported general health status were controlled for. A series of multivariable zero-Inflated Poisson (ZIP) models were used to calculate incidence rate ratios (IRR) for the nonzero scores and odds ratios (OR) of having no event. RESULTS: The weighted prevalence of increased overjet was 8.4%, while it was 23.6% for cross-bite/scissor-bite and 6.7% for increased overbite/open bite. The mean (SE) OHIP-14 (OHRQoL severity) was 2.8 (0.92); the mean score was highest in the pain domain and lowest in the physical and social disability domains. The mean OHIP-14 score was higher in people with increased overjet but not significantly different in people with cross-bite/scissor-bite or with increased overbite/open bite. In multivariate ZIP models, people with increased overjet had a 10% higher OHIP-14 score than people with normal overjet. Increased overjet was associated only with the physical disability domain. Cross-bite/scissor-bite was associated only with the social disability domain, and psychological disability was associated with increased overbite/open bite. CONCLUSION: People with increased overjet had significantly poorer OHRQoL than people with normal overjet in a nationally representative population of Finnish adults ≥30 years. Other malocclusion traits were not associated with OHRQoL. However, all three malocclusion traits were associated with either physical or psychological or social disability domains of the OHRQoL.

An analysis of residual orthodontic treatment need in municipal health centres.

OBJECTIVE: The aim of this study was to analyse residual orthodontic treatment need in Finnish municipal health centres. SUBJECTS AND METHODS: A random sample of two age groups, 16- and 18-year-olds (n = 2212), from seven municipalities was invited for a clinical examination, and 1041 adolescents participated. Two calibrated orthodontists blindly examined the participants for residual treatment need, applying the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Self-perceived treatment need, satisfaction with occlusal function, and dental appearance were evaluated with a questionnaire. Differences between objective and self-perceived treatment need and between treated and untreated adolescents were analysed using the chi-square test. RESULTS: A total of 18.8 per cent of all adolescents had DHC grade 4 or 5 and/or AC category 8-10, indicating a definite need for treatment. In the analysis between treated and untreated adolescents, orthodontic treatment history or gender had no statistically significant association with the objectively defined need (P > 0.05). Self-perceived treatment need was reported by 9.6 per cent of adolescents. This need was more common among treated (13.9 per cent) than untreated (4.6 per cent) adolescents (P < 0.001). Among all adolescents, satisfaction with occlusal function was high, 91.3 per cent; 78.9 per cent of adolescents were satisfied with their dental appearance. The main reasons for dissatisfaction and self-perceived need were visible contact point displacements. CONCLUSIONS: The observed proportion of residual orthodontic treatment need is in line with earlier findings. The high satisfaction with occlusal function reflects the applied selection criteria; orthodontic treatment of displacements causing only aesthetic concern is not prioritized.

Intraparenchymal meningioma mimicking cavernous malformation: a case report and review of the literature.

INTRODUCTION: A primary intraparenchymal meningioma located in the subcortical region of the brain without a dural attachment is extremely rare. To the best of our knowledge, this is the first report showing that meningioma can mimic cavernous malformations. CASE PRESENTATION: We present the case of a 42-year-old German man who presented to our institution with seizure. Both computed tomography and magnetic resonance imaging scans showed characters of an intra-axial subcortical lesion with a 'popcorn' appearance and hemosiderin deposits in the right parietal lobe. The initial diagnosis was cavernous malformation. Intraoperatively, the lesion presented as a subcortical mass that had no connection to the dura or the ventricle. The histological diagnosis showed a WHO Grade 1 'raddled' psammomatous meningioma with extensive metaplastic ossification. A literature review of 29 cases of intraparenchymal meningiomas regarding their clinical presentations, location and management was performed. CONCLUSIONS: Meningiomas can be found in any region of the brain with and without dural attachment. Intraparenchymal meningiomas can have multiple entities mimicking their presentation. Caution must be used regarding the preoperative differential diagnosis.

Long term outcome in patients not initially seizure free after resective epilepsy surgery.

PURPOSE: To assess the long-term seizure outcome and find predictors of outcome for patients who were not initially seizure free 6 months after epilepsy surgery. METHODS: We retrospectively reviewed all adult patients who underwent epilepsy surgery at the Epilepsy Center Bethel, between 1992 and 2003. There were 266 patients included in this analysis. RESULTS: Of the 266 patients who were included in this study, the probability of becoming seizure free was 12% (95%CI 8-16%) after 2 years, 19.5% (95%CI 15-24%) after 5 years and 34.7% (95%CI 28-41%) after 10 years. In patients who had auras only, the probability of being seizure free was 18.2% after 2 years, 25.5% after 5 years, and 39.1% after 10 years. In the multiregression analysis, the EEG carried out 2 years after surgery, a psychic aura, the frequency of postoperative focal seizures and hypermotor seizures predicted seizure remission in the long-term outcome. CONCLUSIONS: The frequency and type of postoperative seizures are critical determinants for long-term outcome. Seizure semiology may be the clue to a precise diagnosis and long-term prognosis of epilepsy.

Apical temporal lobe resection; "tailored" hippocampus-sparing resection based on presurgical evaluation data.

BACKGROUND: It is the aim of epilepsy surgery in patients with lesional epilepsy for the surgeon to not only remove the lesion itself, but also the epileptogenic zone. Here, we report our experience with a modified temporal resection technique confined to the apical temporal lobe, i.e., sparing the hippocampal formation in patients with epileptogenic lesions in the anterior part of the temporal lobe. This apical temporal lobe resection (aTLR) includes tailored lesionectomy, amygdalectomy, and resection of the mesial structures only in the apex of the temporal lobe. This paper presents our surgical technical details and the outcome of aTLR. METHODS: Between 2001 and 2008, aTLR was performed in 61 patients. All patients underwent comprehensive presurgical evaluation including video-EEG monitoring, magnetic resonance imaging (MRI), and neuropsychological testing. All patients had a lesion in the apex of the temporal lobe and a normal hippocampus as seen in MRI, as well as intact memory functions in neuropsychological examination. There were 33 males (54.1%) and 28 females (45.9%). The mean age in years at epilepsy onset was 20.2 ± 13.4, the mean age at epilepsy surgery was 32.1 ± 11.9, the mean preoperative epilepsy duration was 11.8 ± 8.8 years and the mean duration of follow-up was 2.1 ± 1.3 years (range 0.5-6 years). RESULTS: Fifty-four (88.5%) of 61 patients were in Engel Class 1 at 6 months, 38 (80.9%) of 47 at 2 years and nine (81.8%) of 11 at the 5 year follow-up. Histopathological examination showed tumors in 31 patients, FCD in ten patients, amygdala sclerosis in seven patients, cavernomas in six patients, unspecific reactions in eight patients, and gliosis in one patient. Surgical complications occurred in four patients: one had a permanent and three had transient complications which could be successfully treated. Fifty (82%) resections were considered to be complete resections as evaluated by serial postoperative MRI, seven patients (11.5%) had incomplete resection of the preoperative MRI lesion and in four patients (6.6%) it remained unclear. Fifteen patients (29.4%) were withdrawn from antiepileptic drugs for more than 2 years without relapse. Postoperative neuropsychological examination revealed worsening of memory performance in two patients (3.2%) and improved or no changes in the rest of the patients. CONCLUSIONS: Apical temporal resection sparing the mesial temporal structures is an effective procedure with good long-term seizure outcome in patients with refractory epilepsy due to lesions confined to the apex of the temporal lobe.

Acceptability of adolescents' occlusion in Finnish municipal health centres with differing timing of orthodontic treatment.

The objective of the study was to compare the acceptability of occlusion among orthodontically treated and untreated adolescents in eight Finnish municipal health centres applying different timing of treatment. A random sample of 16- and 18-year olds (n = 2325) living in these municipalities was invited for a clinical examination, and 1109 adolescents participated. Two calibrated orthodontists blindly examined the participants for the acceptability of occlusion with the Occlusal Morphology and Function Index. The history of orthodontic treatment was elicited by questionnaire. The impact of the history and timing of treatment on the acceptability of occlusion was analysed with logistic regression analysis. The history of orthodontic treatment decreased the odds for acceptability of morphology [odds ratio (OR) = 0.719, 95 per cent confidence limit (CL), P = 0.016] and acceptability of function (OR = 0.724, 95 per cent CL, P = 0.018). The early timing of treatment increased the odds for acceptability of morphology (OR = 1.370, 95 per cent CL, P = 0.042) and of function (OR = 1.420, 95 per cent CL, P = 0.023). No substantial differences were observed in the acceptability of occlusion between the early and late timing health centres. However, the proportion of subjects with acceptable occlusion was slightly higher in the early than in the late timing group. These findings suggest that when examining the effect of timing on treatment outcome, factors other than acceptability of occlusion should be concomitantly evaluated. Consequently, in this context, the duration and cost of treatment need to be investigated.

Long-term outcome and determinants of quality of life after temporal lobe epilepsy surgery in adults.

AIM OF THE STUDY: To find determinants of quality of life (QOL) in long-term follow-up after temporal lobe epilepsy (TLE) surgery in adults. METHODS: The QOLIE-31 questionnaire was sent to 400 of 524 patients who were operated on for refractory TLE between 1991 and 2003 in the Bethel Epilepsy Centre fulfilling the inclusion criteria of this study. Mainly patients with severe cognitive deficits and patients with progressive brain disorders were excluded. There were 222/400 patients who replied to the QOLIE-31 questionnaire and 147/222 of these patients replied to an additional questionnaire. RESULTS: Univariate analyses showed that seizure freedom, presence of auras, intake of antiepileptic drugs (AEDs), severity of AED side effects, and driving a car were significantly correlated with all subscales of QOLIE-31. Furthermore, employment status, psychiatric problems, tumors and hippocampus sclerosis pathology, the presence of a partner, age at reply, age at surgery and medical co-morbidities were significantly correlated with some subscales of the QOLIE-31. Multivariate analyses (stepwise regression analyses) revealed that especially the time since the last seizure and the severity of AED side effects had a strong impact on QOL. However, aura at last follow-up, psychiatric treatment and employment were seen in the multivariate analyses as significant predictors of some QOL subscales as well. Most subscales of QOL showed a steep, non-linear increase within the first years of seizure freedom and remained relatively stable except for cognitive function which showed continuous improvement parallel to seizure freedom. For patients who were seizure free since surgery, side effects of AED and/or psychiatric treatment were the strongest determinants of QOL. CONCLUSION: Duration of seizure freedom and AED side effects have the strongest impact on QOL in the long-term follow-up. Therefore it is important not only to register intake of AEDs but also to assess side effects of AEDs. Persistence of auras also had an impact on different facets of QOL, but was significantly correlated with intake of AEDs. Apart from factors directly related to epilepsy QOL was dependent of psychosocial factors as employment status, psychiatric complications, and driving a car underlining the necessity of postoperative rehabilitation in this group.

Acceptability of dental appearance in a group of Finnish 16- to 25-year-olds.

OBJECTIVE: To define a grade in the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) that would differentiate between esthetically acceptable and unacceptable occlusions and that would also be both subjectively and objectively meaningful. MATERIALS AND METHODS: Dental appearance and self-perceived orthodontic treatment need were analyzed in a group of Finnish young adults (171 males, 263 females, age range 16-25 years). Subjective data were gathered using a questionnaire, and the respondents were requested to score their dental appearance on a visual analog type 10-grade scale. Professional assessment of dental appearance was performed by two orthodontists using the AC of the IOTN. The cutoff value between esthetically acceptable and unacceptable occlusions was defined using receiver operating characteristic curves. RESULTS: Sixty-six percent of orthodontically treated and 74% of the untreated respondents were satisfied with their own dental appearance. Every third respondent reported one or more disturbing traits in their dentition. The most frequently expressed reason for dissatisfaction was crowding; girls expressed dissatisfaction more often than boys did (P = .005). A self-perceived treatment need was reported infrequently by 8% of orthodontically treated and 6% of untreated respondents. In the logistic regression analysis, self-perceived need for orthodontic treatment was the only significant factor explaining dissatisfaction with own dental esthetics. On the applied scales, grades 1 and 2 fulfilled the criteria for satisfactory dental esthetics. CONCLUSION: The results suggest that the AC grade 3 could serve as a cutoff value between esthetically acceptable and unacceptable occlusions.

Trends in finnish public orthodontic care from the professionals' perspective.

The study maps out orthodontic care in Finnish municipal health centres in 2001, describes changes during the previous ten years reported by chief dental officers, and assesses the views of orthodontists on current public orthodontic services. The data were collected by questionnaires sent to all health centres and all orthodontists in Finland. Of all 0-18-year-olds, 11% were receiving orthodontic treatment with an appliance (range 2-43% among the health centres). The most frequently used appliances were headgear, quadhelix, and fixed appliances. Limited economic resources and the lack of orthodontic expertise were mentioned by the chief dental officers as factors decreasing the volume of services. The orthodontists mentioned the large regional variation and the lack of national guidelines as the most important aspects that should be improved on a national basis. To bring about improvement, they suggested increasing the number of specialist orthodontists and the delegation of orthodontic tasks to auxiliaries.

Orthodontists' views on indications for and timing of orthodontic treatment in Finnish public oral health care.

The aim of this study was to analyse the variation in the views of Finnish orthodontists on the indications for orthodontic treatment, timing of orthodontic assessment, and treatment methods used. The views were elicited by a questionnaire that was sent to all 146 specialist orthodontists under 65 years of age living in Finland in 2001. The response rate was 57 per cent. The association between an orthodontist's experience and timing of treatment was tested by Fisher's exact test. Stepwise logistic regression analysis was used to estimate the association between the demographic characteristics of orthodontists and the tendency to start Class II division I treatment early. Most orthodontists recommended that the first assessment of occlusion should be carried out before 7 years of age. A crossbite was mentioned as the most frequent indication for treatment in the primary and early mixed dentition, and a severe Class II division I malocclusion with an increased overjet as the most frequent indication in the late mixed dentition. Most respondents preferred early treatment, but there was a wide variation in the choice of appliances and in the timing of treatment of malocclusions other than crossbite and Class II malocclusions. A quadhelix, headgear, and the eruption guidance appliance were the most frequently used appliances in early treatment, with fixed appliances being most frequently used during the late mixed and permanent dentition phase. Orthodontists working full time in municipal health centres tended to prefer early treatment more often than those working part-time or outside health centres. There was no statistically significant association between an orthodontist's experience and timing of Class II division I and Class III treatment (P = 0.142 and P = 0.296, respectively). The preference for an early start in Class II division I treatment might be related to differing professional decisions, but no explaining factors could be found in the regression analysis.

TMD in relation to malocclusion and orthodontic treatment.

OBJECTIVE: The aim of this systematic literature review was to evaluate associations between different malocclusions, orthodontic treatment, and signs and symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: This review was part of a project at the Swedish Council on Technology Assessment in Health Care focusing on malocclusion and orthodontic treatment from a health perspective. As a first step, the literature was searched in the Medline and Cochrane Library databases from 1966 to May 2003. A later update was made in January 2005. Human studies in English or in Scandinavian languages were included. RESULTS: Associations between certain malocclusions and TMD were found in some studies, whereas the majority of the reviewed articles failed to identify significant and clinically important associations. TMD could not be correlated to any specific type of malocclusion, and there was no support for the belief that orthodontic treatment may cause TMD. Obvious individual variations in signs and symptoms of TMD over time according to some longitudinal studies further emphasized the difficulty in establishing malocclusion as a significant risk factor for TMD. A considerable reduction in signs and symptoms of TMD between the teenage period and young adulthood has been shown in some recent longitudinal studies. CONCLUSIONS: Associations between specific types of malocclusions and development of significant signs and symptoms of TMD could not be verified. There is still a need for longitudinal studies.

Long-term stability of orthodontic treatment and patient satisfaction. A systematic review.

OBJECTIVE: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. MATERIALS AND METHODS: Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. RESULTS: The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. CONCLUSIONS: This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

Multiple cerebral aneurysms in factor VII deficiency.

A rare case of multiple cerebral aneurysms and factor VII deficiency is presented. The authors hypothesize a possible combined genetic defect similar to that of other conditions with clotting disorders. Different treatment options are discussed for factor VII deficiency in particular and multiple cerebral aneurysms in general. The authors advise treatment of all detected aneurysms in case of a subarachnoid hemorrhage rather than only treatment of the ruptured aneurysms in order to immediately start the so-called triple-H therapy.

Occlusal status in orthodontically treated and untreated adolescents.

In order to evaluate the outcome of orthodontic care, all available 16-year-old adolescents (n = 138) living within the catchment area of one Finnish health center were invited for a clinical examination. A total of 126 adolescents participated, corresponding to 79% of the whole age cohort. Of these, 47% had been treated orthodontically, 2% were still wearing appliances, and 51% were untreated. In 80% of cases, a non-extraction treatment was carried out. All occlusions were evaluated using a recently developed occlusal morphology and functional index (OMFI) based on assessment of 6 morphological and 4 functional traits which are classified applying an acceptable-non-acceptable dichotomy. The occlusal status in untreated individuals was used as a second reference in comparisons between the treated and untreated occlusions. The morphological criteria for an acceptable occlusion were met by 42% of the participants and the functional criteria by 64%. Although the treated occlusions failed to meet the criteria of morphological acceptability more often than the untreated ones (73% vs 40%), the proportions of non-acceptable occlusions were fairly high among untreated occlusions. The main reasons for non-acceptability were the failure of the canine relationship, overbite, and protrusion movement to fulfill the criteria of acceptability. Only 19% of the adolescents had occlusions classified as acceptable, both morphologically and functionally. In the evaluated health center, the allocation of resources resulted in a high coverage of orthodontic care. However, our results indicate that the general occlusal status in the examined age cohort did not reach an optimal level.

Ruptured intracranial dermoid cysts.

BACKGROUND: Intracranial dermoid cysts are rare congenital neoplasms that are believed to arise from ectopic cell rests incorporated in the closing neural tube. The rupture of an intracranial dermoid cyst is a relatively rare event that typically occurs spontaneously. In the past it was believed that rupture is always fatal, a hypothesis that is not supported by more recently reported cases. The symptoms associated with rupture vary from no symptoms to sudden death. METHODS: The present paper analyzes published cases of ruptured intracranial dermoid cysts in terms of their age profile and their clinical presentation and describes an additional case. RESULTS: Analysis of published cases revealed headache (14 out of 44 patients; 31.8%) and seizures (13 out of 44 patients; 29.5%), to be the most common signs of rupture followed by, often temporary, sensory or motor hemisyndrome (7 out of 44 patients; 15.9%), and chemical meningitis (3 out of 44 patients; 6.9%). CONCLUSION: Headache occurred primarily in younger patients (mean age 23.5 +/- 9.3 years), whereas seizures primarily occurred in older patients (mean age 42.8 +/- 11.3 years). The patients with sensory or motor hemisyndrome associated with rupture of an intracranial dermoid cyst showed a more homogeneous age distribution (mean age 38.4 +/- 23.5 years).

Selection of criteria for assessment of occlusal acceptability.

There is no general agreement on criteria that could be applied to distinguish between orthodontically acceptable and non-acceptable occlusions after the completion of dental development. The aim of the present study was to analyse morphological and functional features that could be used as an index to define an acceptable occlusion in young adults. Three expert panels representing specialists in orthodontics and stomatognathic physiology participated in a modified Delphi method. Each panel responded to a questionnaire concerning the usefulness of various occlusal features, and a set of characteristics was selected on the basis of the responses; thereafter, applicability of the chosen characteristics and their cut-offs for an acceptable non-acceptable dichotomy was tested clinically. To obtain a consensus level of 100%, the last panel session was completed with a group discussion. Assessments made using the morphological criteria were compared with those made with the dental health component of the Index of Orthodontic Treatment Need. The selected morphological characteristics consisted of overjet, overbite, canine relationship, crossbite, scissors bite and midline deviation. The functional evaluation comprised assessments of discrepancy between the centric relation and the intercuspal position, working- and non-working-side contacts and protrusion contacts. The dental health component and our morphological criteria showed different sensitivity to contact point displacements, interdigitation in buccal segments and increased overbite. This study provides a set of morphological and functional indicators reflecting the current consensus opinion of Finnish professionals. Further studies are needed to analyse the reproducibility of assessment of the characteristics included.

Reproducibility of characteristics assessing the occlusion of young adults.

The aim of the present investigation was to analyze the reproducibility in the assessment of six morphological and three functional characteristics included in a new method evaluating the occlusion in young adults. These characteristics comprised coincidence of midlines, overjet, overbite, canine relationship, crossbite, scissors bite, recurrent deviation on opening, guided lateral excursions, and discrepancy between the centric relation and the intercuspal position. The study was conducted in three stages: (1) five observers assessed the occlusions of five volunteers, (2) seven observers assessed nine volunteers, and (3) five observers assessed nine volunteers. Two calibrated orthodontists were used as references. For numerical variables, the nonparametric method for repeated measurements (Friedman's test) was used to test the significance of differences, while the proportion of agreement was calculated for categorical assessments. The results were analyzed using two precision levels: within a measurement unit/the same category and an acceptable/nonacceptable dichotomy. The magnitude of systematic differences was small and of minor clinical importance except in measurements of recurrent deviation on opening. The proportional agreement for acceptance was good in the assessment of overjet, coincidence of midlines, crossbite, scissors bite, open bite, and discrepancy between the centric relation and the intercuspal position. Moderate agreement was achieved in the assessment of overbite, canine relationship, recurrent deviation on opening, and guided lateral excursions. Among the nonacceptable cases, the agreement ranged from poor to good. The results indicated that noncalibrated observers assess categorical characteristics inconsistently.