Botulinum toxin treatment of temporomandibular joint pain in patients with bruxism: A prospective and randomized clinical study.

BACKGROUND: Bruxism is a parafunctional habit, usually performed in sleep, by rhythmic and involuntary teeth being squeezed or squeaked. The most common methods of treatment are the use of occlusal splints. AIMS: The aim of this study was to compare the efficacy of occlusal splinting with botulinum toxin administration in the treatment of TMJ pain. SUBJECTS AND METHODS: For this purpose, 40 patients with bruxism were divided into two groups and one group was treated with occlusal splint and the other group received masseter muscle botulinum toxin injection. Then, the participants in both groups were evaluated in terms of pain, functional movement, and maximum bite force change at 2 weeks, 6 weeks, 3 months, and 6 months. Mann-Whitney U test was used to examine the differences between two independent groups. While Friedman test was used for differences between dependent groups, the Wilcoxon test was used for the differences between two repetitive measurements. Chi-square test was used to examine the relationship between categorical variables. Results: When pain was evaluated, both methods were effective in pain reduction, botulinum toxin injection was found to be less effective in reducing pain but no difference was found between the two methods. The maximum bite force decreased in the 2nd and 6th weeks and increased in the 3rd and 6th months in patients receiving botulinum toxin. In patients using occlusal splints, there was no change until the 3rd month and an increase was seen in the 6th month. In this study, it was observed that low dose BTX-A and occlusal splint use were effective in eliminating bruxism-related pain but not superior to each other. CONCLUSIONS: According to these results, low dose botulinum toxin can be considered as an alternative treatment in patients who cannot use occlusal splint for various reasons.

Factors affecting anxiety-fear of surgical procedures in dentistry.

AIM: To compare dental anxiety and fear during procedures performed under local anesthesia either in the operating room or in the clinic as well as to investigate the potential factors that might influence this psychological condition. SUBJECTS AND METHODS: Patients who were admitted to the Department of Oral and Maxillofacial Surgery of the universities in two cities, which have a different sociocultural patient profile, were enrolled. In addition to the State-Trait Anxiety Inventory (STAI), Dental Anxiety Scale (DAS), and Dental Fear Scale (DFS), the patients were asked to answer the questions concerning previous dental experience, education level, and previous psychiatric therapy. STATISTICAL ANALYSIS USED: The results of STAI were analyzed by Mann-Whitney U-test and results of DAS and DFS were analyzed by one-way analysis of variance test. RESULTS: Two hundred patients, of whom 76 were enrolled in the first center and 124 were enrolled in the second center. A statistically significant difference was observed in state anxiety levels of the patients between the two centers, whereas the difference in trait anxiety levels was not significant. The results of DAS, DFS, and STAI-trait (STAI-T) displayed a significant difference between genders; the levels of anxiety and fear were higher in females than in males (DAS P = 0.025, DFS P = 0.017, STAI-T P = 0.045). Comparison between the patients with and without previous dental experience revealed a statistically significant difference regarding the results of STAI. CONCLUSIONS: The study found that sociocultural structure and gender are the significantly effective factors on dental anxiety and fear.

Procalcitonin: a novel cardiac marker with prognostic value in acute coronary syndrome.

Procalcitonin (PCT) is implicated as an inflammatory marker in early atherosclerosis. In order to investigate the clinical consequences of increased PCT levels in acute coronary syndrome (ACS), 77 patients (29 with non-ST-elevation myocardial infarction [MI], 34 with ST-elevation MI and 14 with unstable angina pectoris) were included and followed up for 6 months. The PCT levels were determined at initial presentation and within 48 h of admission. Five patients died during hospitalization and their PCT levels within 48 h of admission were significantly higher than survivors (n = 72) (0.588 +/- 0.56 versus 0.399 +/- 1.33 ng/ml, respectively). The PCT levels within 48 h post-admission in the nine patients who died within 6 months were also significantly higher compared with the survivors (0.451 +/- 0.44 versus 0.406 +/- 1.37 ng/ml, respectively). It is concluded that higher PCT levels within 48 h post-admission may reflect an inflammatory state that is associated with increased early and 6-month mortality.

Role of enoxaparin resistance in recurrent chest pain in the intensive care unit.

To investigate the relationship between anticoagulation treatment and drug resistance in chest pain, levels of factor Xa residual activity were determined in patients seen in intensive care with recurrent chest pain and compared with levels in patients who had no ischaemic events during hospitalization. A total of 122 patients aged 18 - 75 years who were admitted to hospital with acute coronary syndrome and treated with enoxaparin were included. Of these, 62 patients had recurrent chest pain while hospitalized (group A) and 60 patients had an uneventful follow-up period (group B). Patients requiring primary percutaneous transluminal coronary angioplasty and/or treatment with glycoprotein IIb/IIIa inhibitors, and those with renal failure, a high risk of bleeding or receiving anti-inflammatory drugs were excluded from the study. Median levels (+/- interquartile range) of factor Xa residual activity were significantly higher in group A compared with group B (0.68 +/- 0.29 IU/ml versus 0.34 +/- 0.33 IU/ml). It is concluded that enoxaparin resistance, resulting in high levels of factor Xa residual activity, should be considered in patients with recurrent ischaemia.

Effect of Candida albicans septicemia on the cardiovascular function of rabbits.

Candida albicans is an opportunistic pathogen that causes life-threatening systemic infection in immunocompromised host. However, little is known about the effects of yeast on the cardiovascular functions. This study examined the effects of C. albicans septicemia on the heart and vessel functions and nitric oxide (NO) production in infected rabbits. Anaesthetized animals were challenged with intravenous C. albicans (6 x 10(8)/kg) or saline and the blood pressure of rabbits were measured over 5 h. After that response of the isolated thoracic aorta, right atrium and left papillary muscle were recorded. Blood pressure significantly decreased in the infected rabbits during the septicemia but in the control animals it was stable. The blood nitrite levels and NO-synthases (eNOS, iNOS) expression and tissue nitrite levels in the heart and aorta were similar in the both groups. In the aorta isolated from C. albicans-infected rabbits, acetylcholine-induced endothelium-dependent relaxation was decreased, but contractions induced by phenylephrine were potentiated. The NOS inhibitor, L-N(G)-nitro-arginine methyl ester (L-NAME)-induced contraction increase in the right atrium was depressed by the yeast-infection. In the heart and aorta, microscopic examination revealed no tissue invasion of C. albicans. These results indicate the ability of C. albicans-induced septicemia to destroy NO-related responses of the heart and aorta and may have important implications for functional damage to endothelium and the regulation of cardiovascular functions. In addition, NOS induction and NO over-production are not stimulated by systemic C. albicans infection, which would alter the host immune reaction and homeostasis.

Temporomandibular internal derangement: correlation of MRI findings with clinical symptoms of pain and joint sounds in patients with bruxing behaviour.

OBJECTIVES: The aim of this study was to correlate magnetic resonance imaging (MRI) findings of effusion, disc displacement, condylar bony changes and disc form with clinical findings of pain and sounds in patients with bruxing and non-bruxing behaviour. METHODS: Disc displacement was confirmed by MRI in 102 joints from 64 patients (total of 128 joints) with bruxing behaviour who were referred for clinically diagnosed internal derangements of the temporomandibular joint (TMJ). Sixty joints with internal derangement from 30 patients without bruxing behaviour served as a control group. The clinical inclusion criteria were pain in the pre-auricular area and muscles of mastication, limitation or deviation in mandibular range of motion, and TMJ sounds. Signs of bruxism were diagnosed clinically and were obtained from the patient's history given on their first visit. Pain was evaluated using a visual analogue scale. RESULTS: Of the 102 joints in the study group with disc displacement, 53 (52%) showed disc displacement with reduction and 49 (48%) showed disc displacement without reduction. In the control group, 16 joints were classified as normal. Of the remaining 44 joints, 27 (61%) had disc displacement with reduction and 17 (39%) had unilateral disc displacement without reduction. Condylar bony changes were seen in 55% of the reducing joints in the study group and in 38% of the reducing joints in the control group, compared with 86% of the non-reducing joints in the study group and 24% of the non-reducing joints in the control group. There was a strong correlation between age and degenerative change in the study group. In the reducing joints, there was a significant difference in the prevalence of condylar bony changes between the study and control groups (P<0.01). In non-reducing joints, 30% of painful joints in the study group and 59% of those in the control group showed a strong signal in the joint space on T(2) weighted imaging. Statistically significant differences between the study and control groups were also found for disc form and the prevalence of effusion and disc displacement. Joint sounds were important in unilaterally affected joints in the study group. A statistically significant correlation was found between joint sounds and reducing joints (P<0.05). CONCLUSION: It was demonstrated that a higher prevalence of condylar bony changes occurred in reducing joints in patients with bruxing behaviour.

Posterior segmental osteotomy of maxillary edentulous ridge: an alternative to vertical reduction.

The posterior segmental maxillary osteotomy (PSMO) can be used as an alternative procedure to vertical reduction of the edentulous posterior maxilla. Surgical intrusion of the segment resulted in an adequate interarch space for prosthetic restoration without cortical bone loss and widening of the edentulous ridge and the mobilized keratinized mucosa as would be the case if vertical alveolar reduction had been performed.

Interleukin-1beta and tumour necrosis factor-alpha levels in periapical exudates.

AIM: The aim of this study was to determine IL-1beta and TNF-alpha levels in periapical exudates and to evaluate their relationship with clinical and radiological findings. METHODOLOGY: Periapical exudates were collected from root canals of 35 single-rooted teeth using absorbent paper points. IL-1beta and TNF-alpha levels were determined by enzyme-linked immunosorbent assays. The samples were divided into two groups according to the presence or absence of clinical signs including swelling and/or fistula, pain on palpation and/or percussion, and pus discharge from canals. Periapical exudate samples were divided into two groups according to size of periapical radiolucent area. RESULTS: The mean concentration of IL-1beta (72.79 ng mL-1) in periapical exudates was approximately 12-fold higher than TNF-alpha(6.17 ng mL-1). There was no significant correlation between these cytokines (P > 0.05). IL-1beta levels in canals with larger radiolucent areas (long axis > or =1 cm) were significantly higher than those with small areas (P < 0.05). There was a tendency toward higher levels of IL-1beta in groups with clinical signs, but the differences were not significant (P > 0.05). CONCLUSIONS: Periapical exudate levels of both cytokines failed to reflect periapical disease state.

Affinity of Staphylococcus epidermidis to various prosthetic graft materials.

BACKGROUND: Abdominal wall hernias have always been a major problem for general surgeons. The techniques of repairing primary, recurrent, and incisional hernias have evolved throughout the years at an accelerating trend, especially after production of prosthetic graft materials. Although looked upon with suspicion due to infection, fistula formation, and foreign body reaction, prosthetic graft materials are used deliberately in primary and recurrent hernias. The present study was designed to evaluate bacterial adherence to frequently used prosthetic graft materials. MATERIALS AND METHODS: The study was carried out in five different groups with each group consisting of 10 identical samples of the same kind of prosthetic graft material. The prosthetic graft materials used in the study were polypropylene, polyglactin 910, polyester fibers, steel, and polytetrafluoroethylene (PTFE). These prosthetic graft materials were incubated in vitro with a Staphylococcus epidermidis strain which was ++++ adhesion positive. The degree of adhesion of S. epidermidis to prosthetic graft materials was assessed by the ELISA method. RESULTS: Vicryl grafts showed significantly minimal bacterial adhesion whereas PTFE grafts tended to have more adhesion but this did not reach a statistical significance. Other graft materials did not show any difference for bacterial adhesion (Table 3). CONCLUSION: These results suggest that in vitro S. epidermidis adhesion to Vicryl grafts is less than other types of prosthetic graft materials (P < 0.05 for all comparisons). Further in vitro and in vivo studies are required to confirm these results and to understand the complex interactions among bacteria, graft material, microenvironment, and surgical technique.

Effects of different serotypes of Escherichia coli lipopolysaccharides on body temperature in rats.

The effects of Escherichia coli O55:B5, O127:B8, and O111:B4 serotypes' lipopolysaccharides (LPS) on body temperature were investigated in rats. LPSs were injected intraperitoneally at doses of 2, 50, and 250 microg/kg. A multiphasic and no-dose dependent increase in rectal temperature was observed in response to E. coli O55:B5 LPS at all doses, and in response to E. coli O127:B8 LPS at 2 and 50 microg/kg doses. The highest dose of the latter caused a dual change in rectal temperature, in which hypothermia preceded fever. E. coli O111:B4 LPS was either pyrogenic or hypothermic at 2 and 250 microg/kg doses; respectively, whereas a dual response was observed when the 50 microg/kg dose was injected. Although dual responses were observed after administration of all LPSs at 50 microg/kg dose when the body temperature was recorded by biotelemetry, the hypothermia induced by E. coli O55:B5 LPS was significantly smaller. These data suggest that LPSs induce dose and serotype-specific variable changes on body temperature in rats. This variability may be related to the structure of LPSs. The data also indicate that LPS causes hypothermia with or without fever in rats.

Candida albicans and Saccharomyces cerevisiae cell wall mannans produce fever in rats: role of nitric oxide and cytokines.

Mannan components of C. albicans (5 mg/kg, i.p.) and S. cerevisiae (2.5 mg/kg, i.p.) cell walls produced pyrogenic responses which were completely inhibited by indomethacin (5 mg/kg, s.c.) pretreatment in rats. A non-selective NOS inhibitor, L-NAME (10 mg/kg, s.c.), also inhibited the pyrogenic effectiveness of C. albicans mannan, whereas it was ineffective on the fever induced by S. cerevisiae mannan. A selective elevation in the serum TNF-alpha levels was observed at the initial phase of the fever due to S. cerevisiae mannan, whereas there was no significant change on the serum levels of TNF-alpha, IL-1beta and IFN-gamma during the latent period or at the initial phase of the fever induced by C. albicans mannan. Injections of N-linked and/or O-linked oligomannosides of the either mannan did not cause any significant change in the body temperature and serum cytokine levels. These data suggest that the mannan components of C. albicans and S. cerevisiae cell walls produce a prostaglandin-dependent fever in rats. The initial signal for fever seems to be different for each mannan. Data also indicate that integrity of the mannans is necessary for the pyrogenic response.

Inhibition of endothelium-dependent relaxation by Candida albicans.

This study examines the effects of Candida albicans on acethylcholine-induced, endothelium-dependent relaxation of thoracic aorta of rabbits, precontracted by phenylephrine (10(-7) M). Isolated vessel rings were incubated with C. albicans, Saccharomyces cerevisiae, or their mannans, and endothelium-dependent relaxation was measured by the induction of acethylcholine. Endothelium-dependent relaxation remained unaffected after 3 hours by either C. albicans or S. cerevisiae, or their mannans. After 24 hours, however, incubation with C. albicans had completely abolished relaxation, whereas relaxation was decreased by mannan of C. albicans and continued unaffected by S. cerevisiae. In contrast, no change was registered with a 24 hours incubation of C. Albicans in a sodium nitroprusside-induced, endothelium-independent, vascular smooth muscle relaxation. Microscopical investigation of the morphological structure of vessel walls revealed penetration of C. albicans on the intimal surface after 3 hours incubation and infiltration of the yeast through the vessel wall after 24 hours. No changes in vessel morphology occurred after 3 or 24 hours with S. cerevisiae or the mannan of C. albicans. These results show the ability of C. albicans to inhibit endothelium-dependent, but not endothelium-independent, relaxation of vascular smooth muscle and may have important implications for functional damage to endothelial cells and the regulation of vessel tone and blood flow.

Immunologic aspect of testicular torsion: detection of antisperm antibodies in contralateral testicle.

OBJECTIVE: To evaluate the immunologic etiology in unilateral testicular torsion, an experimental study in rats was carried out. MATERIALS AND METHODS: 75 adult Wistar rats included in the study program were divided into six different groups according to a torsion-detorsion procedure. Torsion degree was kept constant for all animals (720 degrees ). Anti-rat immunoglobulin G (IgG) antibodies against spermatozoa antigens were identified in contralateral testicular tissue after 1 month following detorsion and/or orchiectomy of the twisted testicle. RESULTS: We revealed antibody formation in animals subjected to unilateral torsion for 12 and 24 h, which then followed by detorsion of the testicle. IgG was identified especially on basal membrane of the tubules. CONCLUSIONS: As the controversy on the exact mechanism of testicular damage in unilateral torsion still continues, our findings showed that a possible immunological etiology may play an important role in this respect.

Polysaccharide mannan components of Candida albicans and Saccharomyces cerevisiae cell wall produce fever by intracerebroventricular injection in rats.

The cell wall mannan components of Candida albicans and Saccharomyces cerevisiae produced hyperthermic responses when injected intracerebroventricularly at doses of 10 microg in rats. Indomethacin treatment (5 mg/kg subcutaneously) completely abolished these responses. Serum interferon-gamma, tumor necrosis factor-alpha and interleukin-1beta levels showed an upward trend during the initial phase of the hyperthermic response induced by S. cerevisiae mannan. Meanwhile, serum levels of these proinflammatory cytokines did not increase at all at the initial phase of C. albicans mannan-induced hyperthermia. Histopathological examination of the brain tissue samples revealed no specific change throughout the parenchyma of rats given either mannan. These results indicate that the polysaccharide mannan components of yeasts, regardless of the pathogenicity, produce a pyrogenic response by a direct injection into the brain in rats. This response is not accompanied by proinflammatory cytokine induction in the periphery.

Bimaxillary orthognathic surgery in a patient with long face: a case report.

The primary characteristics of long face patients are gummy smile and/or anterior open bite. Consequently, correction of esthetic and functional problems are especially important for long face patients. Since orthodontic therapy alone is not sufficient to solve the problem, orthognathic surgical approach is indicated for these patients. In this report, orthognathic surgical therapy of a severe long face patient with similar findings was presented. Following clinical and cephalometric examination and preoperative orthodontic therapy, a Le Fort I osteotomy, a bilateral sagittal split osteotomy, and vertical and horizontal reduction genioplasties were performed. Alternative surgical therapies, complications, and the effects on the upper respiratory tract are also discussed.

Rhodococcus equi and Nocardia brasiliensis infection of the brain and liver in a patient with acute nonlymphoblastic leukemia.

Resolution of neutropenia is usually followed by resolution of fever in patients with febrile neutropenia. However, in some cases fever continues even when the patient is no longer neutropenic. Described here is a case of acute myeloblastic leukemia complicated by brain abscess, pulmonary nodules, and hepatic lesions. The patient's fever had continued after the neutropenia resolved; brain and hepatic cultures grew Rhodococcus equi and Nocardia brasiliensis. Although Rhodococcus infections occur frequently in patients with HIV infection, they are uncommon in patients with acute leukemia.

Changes in the conjunctival flora after conjunctivodacryocystorhinostomy (CDCR): a preliminary report.

PURPOSE: To describe changes in the conjunctival flora due to retrograde flow after conjunctivodacryocystorhinostomy (CDCR) with Jones' tube implantation. METHODS: In 20 patients, one year after unilateral CDCR with Jones' tube implantation and a functionally successful outcome, conjunctival and nasal mucosal specimens were taken from the operated side for bacteriological analyses and non-operated eye conjunctival specimens were simultaneously taken as the control group. The samples were cultivated in conventional media and also in hypertonic media in order to isolate L-forms of bacteria and to increase the isolation rate and sensitivity. RESULTS: Bacterial growth was detected in 16 operated (80%) and 11 non-operated eyes (55%) and 26 bacteria were isolated from nasal mucosa in 20 cases (isolation rate 100%). Bacteria isolated from the non-operated specimens were S. epidermidis (63.6%, seven cases), S. aureus (27.2%, three cases) and Corynebacterium sp. (9.0%, one case). Conjunctival cultures of the operated eyes yielded S. epidermidis in three (18.7%), S. aureus in six (37.5%), Corynebacterium sp. in two (12.5%) and other bacteria in five (31.3%). Nasal mucosal cultures contained S. epidermidis in nine cases (45%), S. aureus in eight (40%), Corynebacterium sp. in two (10%) and miscellaneous bacteria in seven cases (35%). CONCLUSIONS: After CDCR the conjunctival flora of the eye undergoes differentiation and becomes similar to the nasal flora.

Ig A antibodies to klebsiella in ankylosing spondylitis.

In this study anti-klebsiella Ig A values were compared in 40 patients with definite diagnosis of ankylosing spondylitis and a control group of 40 healthy subjects. Anti-Klebsiella Ig A antibody values were significantly higher in patients with ankylosing spondylitis as compared to the control group (p < 0.001). Correlation between these antibodies and erythrocyte sedimentation rate, CRP, serum Ig A, HLA B 27, age, sex and disease duration was searched, but no correlation was found. In our opinion, these results support the suggestion that inflammatory response in ankylosing spondylitis is triggered by Klebsiella but is insufficient to prove the causal relationship between ankylosing spondylitis and Klebsiella.

Experimental otitis media induced by coagulase negative staphylococcus and its L-forms.

In a previous study, we found 15% L-forms of bacteria (predominately coagulase negative staphylococci (CNS)) in ears which gave negative cultures by conventional methods. In this study, we used an animal model to test whether CNS and its L-forms can be pathogenic and whether L-forms have a crucial role in the tendency to secretory otitis media (SOM). We inoculated the tympanic bullas of guinea pigs, in 2 groups, with CNS and its L-forms (revertant forms). We observed that both CNS and its L-forms had the capability of causing infection. However, it was milder for the L-forms than CNS. We clearly noticed that on day 30 60% of the ears inoculated with L-forms had effusion and/or retraction of the tympanic membrane. These ears were histopathologically characterized by hypertrophied pseudostratified epithelium or stratified squamous epithelial metaplasia. The ears inoculated with the original form of CNS had only 16.66% effusion. On day 60 we observed similar findings. Thus, it might be proposed that L-forms could be responsible for chronic irritation to middle ear mucosa leading to SOM.

Preliminary report on L-forms: possible role in the infectious origin of secretory otitis media.

Infection and inflammation of the middle ear cleft are important factors in the pathogenesis of secretory otitis media. Although high percentages of negative cultures are confronted in many studies, strong evidence pointing to the infectious nature of this disease could not be overlooked. Many authors agree about the failure of conventional culture methods in identifying the responsible pathogen or pathogens. Besides, some agents, such as some kinds of antibiotics, lysozyme, and perhaps some undetected materials, are capable of changing bacterial behavior and consequently the clinical course. Effusions taken from 40 ears with secretory otitis media were cultured by means of conventional brain-heart infusion broth and special hypertonic thioglycollate broth. Strikingly, bacterial L-forms were detected in 6 specimens in thioglycollate broth, with no growth in the conventional broth. We concluded that these atypical forms of bacteria, the L-forms, may play an important role in the bacteriologic aspect of secretory otitis media.