Low-Dose Naltrexone for Excoriation Disorder.

Excoriation (skin-picking) disorder (ED) is a condition characterized by the repeated compulsion to pick at the skin, causing physical trauma and psychiatric distress. Patients often desire to cease skin-picking behavior but are unable to do so. Multiple treatment modalities are effective for ED, including naltrexone. Previous reports of naltrexone for ED were at a high dose of 50 mg. The efficacy of low-dose naltrexone (LDN) at 4.5 mg in managing ED has not been reported. We present a case of a 51-year-old female with ED who was evaluated in the pain clinic for fibromyalgia management. Her medications included gabapentin 600 mg PO TID and a history of opioid prescription for diffuse pain. She was started on naltrexone 4.5 mg PO QD for the management of fibromyalgia. Three months later, the patient reported improvement in her skin-picking disorder, with a lessened compulsion to itch at her skin and improved healing of existing lesions. When the naltrexone was temporarily interrupted for an elective procedure, her lesions worsened. Her lesions improved after she resumed the medication. Thereby, this patient experienced a therapeutic benefit from naltrexone for her skin-picking disorder, as demonstrated by the temporal changes in her symptoms. To our knowledge, this is the first reported case of ED improving with LDN, as other cases utilized 50 mg. Though few clinical trials or systematic reviews recommend the use of naltrexone for EDs, our case supports trialing LDN in the appropriate context.

Comparative evaluation of masticatory efficiency, clinical performance, and patient satisfaction of single implant-retained mandibular overdenture versus conventional complete denture: A prospective in vivo study.

AIM: The aim of this within-subject prospective clinical study was to investigate the scope of single implant mandibular overdenture by assessing its masticatory efficiency, clinical performance, and patient satisfaction compared to conventional complete dentures. SETTINGS AND DESIGN: Prospective In Vivo Study. MATERIAL AND METHODS: This prospective in vivo study was conducted in the Department of Prosthodontics and Crown and Bridge, Christian Dental College, Ludhiana. A total of 12 completely edentulous patients received a single implant in the mandibular anterior midline region. After the healing period, the conventional maxillary and mandibular dentures were fabricated. 15 days post insertion of the conventional dentures, patients were evaluated for masticatory efficiency, clinical performance including retention and stability, and patient satisfaction. To evaluate the masticatory efficiency blue raspberry and original pink "Hubba Bubba tape gum" were used as a test food. Colorimetric analysis was done to assess variance of hue. To assess clinical performance, retention, and stability of the mandibular denture was recorded using a digital force gauge and was tabulated as per CU-modified Kapur's criteria. OHIP-14 index was used to assess patient satisfaction. After evaluation of the parameters of conventional dentures, the denture was converted into an implant-retained mandibular denture by chairside conversion with locator attachments. 15 days post-implant loading, parameters of the implant retained mandibular overdenture were assessed again followed by statistical analysis. STATISTICAL ANALYSIS USED: The masticatory efficiency was assessed using a paired t-test. The patient satisfaction was sequentially assessed with Wilcoxon signed rank test and thereafter paired t-test was used to compare between conventional complete denture and overdenture. Clinical performance was assessed using the Wilcoxon signed rank test. RESULTS: The masticatory efficiency of single implant mandibular overdenture was higher than that of conventional complete dentures. The clinical performance of the overdenture was higher than that of the conventional denture. Stability being a time-dependent parameter might need longer follow-ups for further conclusions. Patient satisfaction with single implant retained overdenture was significantly higher than conventional complete dentures. CONCLUSION: Single implant mandibular overdenture has improved masticatory efficiency, clinical performance, and patient satisfaction compared to conventional complete dentures.

Prosthetic rehabilitation of intraoral defects in patients with rhino-orbital-cerebral-mucormycosis: A systematic review.

AIM: This study aimed to systematically review the frequency and type of intraoral prosthetic rehabilitation in patients with rhino-orbital-cerebral-mucormycosis (ROCM). SETTINGS AND DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MATERIALS AND METHODS: An electronic search was conducted in databases including PubMed, Web of Science, Scopus, and Google Scholar. Case reports that documented prosthetic rehabilitation following surgery in patients with ROCM were included. This review was registered under the International Prospective Register of Systematic Reviews CRD42021262284. Assessment of the quality of the included studies was done using the Joanna Briggs Institute Critical Appraisal Checklist for Case reports, which comprised of an eight-item checklist. The recorded observations were organized and subjected to analysis. STATISTICAL ANALYSIS USED: Qualitative analysis was used. RESULTS: Among the 25 case reports, type IId defect was the most common. Three types of prosthetic treatments were rendered, with the obturator being the most common choice of rehabilitation, followed by implant-retained obturator overdenture and fixed implant-supported prosthesis. Patients undergoing implant-based rehabilitation exhibited a 100% survival rate for implants, with follow-up periods spanning from 6 months to 3 years. No prosthetic complications were reported in any of the included case reports. CONCLUSIONS: The prevailing defect type identified was IId (48%), while the treatment of choice most frequently employed was an obturator (84%). However, with limited evidence available at present, further research is required to draw more definitive conclusions.

Evidence for the Clinical Association between Demodex and Rosacea: A Review.

BACKGROUND: Rosacea is a chronic inflammatory dermatological condition in humans, and its pathogenesis remains unclear. However, the development of rosacea is suspected to be related to Demodex, a microscopic commensal organism that resides in or near hair follicles and sebaceous glands. Although Demodex is known to be a host-specific, obligate commensal organism, it is currently difficult to be cultured in vitro to parasitize and infect other animal hosts. Therefore, direct evidence for a pathogenic role of Demodex in rosacea is currently lacking. SUMMARY: As circumstantial evidence, non-invasive skin-detecting techniques have shown abnormally elevated numbers of Demodex in rosacea patients. Increased cytokine levels such as IL-10, IL-8, and IL-12p70 have been observed in human sebocytes following the Demodex challenge, and acaricides have been found to be effective in rosacea therapy, all point to a close relationship between Demodex and rosacea. Based on these findings, we conducted a comprehensive literature review to summarize the current state of knowledge, research insights, and clinical treatment recommendations for Demodex-associated rosacea, with the ultimate goal of improving patient outcomes.

Digital superimposition of scans for recording and transferring vertical relation from provisional restorations when rehabilitating worn-out dentition: A dental technique.

Excessive wear of the natural dentition results in the loss of tooth anatomy and the vertical dimension of occlusion (VDO) which may necessitate full mouth rehabilitation. Successful full-mouth rehabilitation with increased VDO requires accurate recording and transfer of the newly raised VDO with provisional restorations. Conventional bite registration can incur errors during the recording and transfer of vertical dimensions. This article introduces a digital approach-the superimposition of scans using an intraoral scanner (IOS) to transfer VDO, occlusion, and aesthetic data from provisional restorations for designing and fabricating indirect restorations in the management of worn-out dentition.

Computer-aided design software-enabled preclinical prosthodontic training: A digital education technique.

The prosthodontics preclinical training modules involve textbook-based two-dimensional (2D) ideal images and practicing on manikin models to emulate ideal tooth preparations and teeth arrangements. Relying solely on 2D images as objectives for preclinical exercises limits the trainee's creative skills to instructions of textbooks and clinical instructions received. With advancements in digital dentistry, dental trainees should have early exposure to the three-dimensional (3D) rendering of ideal preclinical objectives. A dental education technique using computer-aided design software and smartphones is described that will allow 3D rendering of ideal prosthodontic training assignments allowing early exposure to digital dentistry for dental training students.

Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis.

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.

Surface trueness and precision of interim restorations fabricated by digital light processing and CAD-CAM milling systems.

STATEMENT OF PROBLEM: The development of digital dental technologies has enabled clinicians to use additive and subtractive manufacturing techniques to fabricate interim restorations. However, knowledge of the trueness and precision of such restorations fabricated using digital light processing (DLP) and computer-aided design and computer-aided manufacturing (CAD-CAM) methods is limited. PURPOSE: The purpose of this in vitro study was to assess and compare the accuracy of interim crowns fabricated using DLP and CAD-CAM methods. MATERIAL AND METHODS: A typodont mandibular first molar was prepared for a ceramic crown, and a digital scan (Medit T500) was obtained to design interim crowns by using the CAD software program. The CAD data were designated as the reference data. A total of 20 crowns were fabricated by DLP and CAD-CAM technology. The fabricated interim crowns were further scanned using a laboratory scanner and were superimposed with the CAD data by using a 3-dimensional (3D) point cloud assessing software program (CloudCompare) for the evaluation of trueness and precision. Root mean square values (RMS) were obtained for the evaluation of discrepancies. The Student t test was used to compare data as the Shapiro-Wilk test confirmed the normal distribution. RESULTS: RMS values for the trueness values of the external and intaglio surfaces of the 3D printed and milled interim crown displayed no statistically significant differences (P>.05). Precision for the external surface reported significance (P<.05), whereas that for the intaglio surface reported no significance (P>.05). CONCLUSIONS: The accuracy of interim crowns fabricated by using DLP was comparable with that of milled crowns. Both manufacturing systems produced a true reproduction of the CAD. As for precision, the external surface of the DLP interim crown was statistically different from that of the milled group as it relates to the CAD.

Factors Associated With Growth in Patients Treated With the Classic Ketogenic Diet for Drug-Resistant Epilepsy.

BACKGROUND: Suboptimal growth and malnutrition are often cited as complications of ketogenic diet therapy in patients with drug-resistant epilepsy; however, there is conflicting evidence on the factors that contribute to growth. METHODS: This is an observational, case-based study to evaluate growth in patients with drug-resistant epilepsy treated with the classic ketogenic diet for at least 12 months. Age, gender, height, weight, and body mass index (BMI) were collected at baseline and epilepsy clinic standard-of-care visits (one month, six months, and 12 months after diet initiation). Dietary intake and laboratory measures including glucose, bicarbonate, and beta-hydroxybutyrate were also collected. RESULTS: 119 patients were included. After ketogenic diet initiation, there was a significant fall in height z score from baseline to 12 months (-0.15, P = 0.001) but no other significant changes in weight, weight-for-length/BMI, or height z scores were noted between any time points within the 12 months after diet initiation. When separated by age, height z score changes were limited to those aged zero to three years. This was accompanied by a significant decrease in energy intake 12 months after treatment in this age group. When separated by diet route, weight z scores at each time point were significantly lower in the group eating by mouth than tube. CONCLUSIONS: Our study provides further evidence that the classic ketogenic diet impacts growth. Our population demonstrated restriction in linear growth in those aged zero to three years, which correlated with declines in energy intake, and weight declines limited to patients fed by mouth.

Minocycline-Induced Hyperpigmentation of Nails.

Minocycline is an antibiotic used for several dermatologic conditions, including rosacea. The development of skin, scleral, and nail hyperpigmentation may occur with long-term use of minocycline, and this is associated with no adverse effect on function. We present a case of a 66-year-old male who developed blue-gray hyperpigmentation of his nail beds after treating rosacea with systemic minocycline for over 20 years. The remainder of the physical exam was unremarkable for hyperpigmentation elsewhere. The patient was informed that this was likely an adverse effect of his chronic minocycline use. He insisted upon the continuation of minocycline, so he was counseled on the adverse effects of the medication and scheduled for follow-up.

A smartphone application with a gray card for clinical shade selection: A technique.

Shade selection is an inherently complex procedure, and its accurate reproduction in the definitive restoration involves an in-depth understanding of color science and its effective communication with the dental laboratory technician. A technique is presented that uses a smartphone application (Snapseed; Google LLC) and a gray card for clinical shade selection.

Three-dimensional finite element analysis of zygomatic implants for rehabilitation of patients with a severely atrophic maxilla.

STATEMENT OF PROBLEM: Stresses applied to zygomatic implants have been determined to be transferred mainly to the zygomatic bone; however, consensus regarding the stress distribution pattern in the bone surrounding zygomatic implants has not yet been reached. PURPOSE: The purpose of this 3-dimensional (3D) finite element analysis (FEA) study was to visually compare the stress distribution pattern in 2 different zygomatic implant treatment modalities and evaluate the effect of masseter musculature involvement. MATERIAL AND METHODS: A 3D FEA craniofacial model was constructed from the computed tomography (CT) data of a selected patient with a severely atrophic edentulous maxilla. Modeled zygomatic and conventional implants were inserted into the craniofacial model supporting a prosthesis superstructure. Two types of treatment were considered in the study: 2 zygomatic implants placed bilaterally or 2 zygomatic implants placed in conjunction with at least 2 conventional implants at the anterior maxilla. The models were loaded with a vertical force of 150 N, a lateral force of 50 N, and a distributed occlusal force of 300 N applied to the insertion area of the masseter muscle. The stresses on and deformations of the bones and implants were then observed and compared with and without the involvement of the musculature component. RESULTS: The stresses were distributed efficiently along the vertical and horizontal facial buttresses, as in the dentate skull; however, a difference in distribution pattern was observed when the models were loaded without applying the muscle component. The maximum deformation of bones surrounding the implants occurred in the abutment connection of the conventional anterior implant in the model with an additional conventional anterior implant. CONCLUSIONS: The FEA revealed the stresses were distributed efficiently along the vertical and horizontal facial buttresses, as in the dentate skull. However, the stresses in both models were concentrated in the zygomatic bone when incorporating the muscle component. Therefore, incorporating muscular force into FEA studies could affect the analysis result.

A User-Friendly Technique for Replacing Nylon Inserts of a Locator Attachment.

Rehabilitation of edentulous patients with implant-supported overdentures has gained prominence over the use of conventional dentures because of the improved quality of life it provides patients. Various attachment systems are available that facilitate the insertion and removal of prostheses, and among them, the Locator attachment system has become popular due to its self-aligning property, simplicity of use, and minimal space requirement of male inserts within the denture. However, the loss of retention of nylon inserts over time requires their removal from the metal housing and subsequent replacement. This article describes an easy alternative technique for replacing the nylon inserts in the denture cap using a simple dental explorer and mirror head.