The future of oral and maxillofacial surgery - retired viewpoint.

A reasoned argument as to why the status quo for oral and maxillofacial surgery training is not sustainable and an alternative is suggested. It is argued that the current financial burden, future pension provision and unacceptable work/life balance must be addressed immediately to ensure uptake of training posts for preservation of the specialty.

A new model for demonstrating enamel protection benefits relative to acid challenge.

OBJECTIVE: To determine the applicability of a modified US FDA Caries Monograph test method for measuring the protective benefits of fluoride (F) against erosive, dietary acids. METHODS: Acid-challenged teeth were treated in two studies with a dentifrice, rinsed, and then re-challenged in a series of tests using three dietary acids. Study 1 included dentifrices containing 1450 ppm F as sodium fluoride (NaF) + triclosan [A], 1450 ppm F (NaF) + potassium nitrate (KNO3) [B], 1000 ppm F as sodium monofluorophosphate (SMFP) [C], and 0 ppm F (placebo) [D]. Study 2 included dentifrices containing 1450 ppm F (NaF) [A]; and 0 ppm F (placebo) [B]. Acids were analyzed for phosphate removed during tooth challenges, with post-treatment results compared to baseline. Results were averaged and reported as a % protection value for each product, with higher values indicating greater protection. RESULTS: Study 1: % protection for A = 16.4; B = 13.0; C = 7.1; and D = -5.2. Study 2: A = 15.2; B = -10.5, with A = B > C > D: Study 1; and A > B: Study 2. In each study, p < 0.05, ANOVA. CONCLUSIONS: The model provides a viable tool for initially assessing the potential for fluoride-containing oral care products to protect teeth against erosive, dietary acids. This can then lead to further and more elaborate testing with reasonable expectations for outcomes.

Comparison of fluoride uptake into tooth enamel from two fluoride varnishes containing different calcium phosphate sources.

OBJECTIVE: The objective of this in vitro study was to compare two 5% sodium fluoride varnishes, each containing different sources of calcium and phosphate, for their ability to deliver fluoride into treated sound tooth enamel and adjacent, but untreated demineralized enamel. METHODS: Six sets of 12 bovine enamel cores were mounted in plexiglass rods and the exposed surfaces were polished. Synthetic lesions were formed in the surface of three sets by soaking in thickened, pH 5.0, 1M lactic acid, 50% saturated with calcium hydroxyapatite. A fluoride varnish containing tri-calcium phosphate (TCP) was applied to one set of sound enamel cores, and a second, delivering amorphous calcium phosphate (ACP), was applied to another. A third set of sound enamel cores was water-treated. Each treated sound core was paired with an untreated lesioned core, and the pairs were soaked in artificial saliva for 24 hours at 37 degrees C. The treated cores, but not their lesioned counterparts, were initially soaked in 1.0 N KOH saturated with calcium phosphate for 18 hours. Each core was separately etched with 1.0 N perchloric acid for exactly 15 seconds, and fluoride measured by an ion-sensitive electrode after neutralizing with NaOH and buffering in TISAB II. The amount of calcium extracted was also determined by atomic absorption spectrophotometry as a measure of etch depth. RESULTS: Fluoride uptake average was 1677 +/- 193 ppm, 455 + 38 ppm, and 44 +/- 5 ppm for the sound enamel cores treated with ACP varnish, TCP varnish, and water treatment, respectively. Fluoride uptake into the demineralized enamel averaged 5567 +/- 460 ppm, 2126 +/-126 ppm, and 49 -/+ 4 ppm for demineralized enamel paired with the sound cores treated with ACP varnish, TCP varnish, and water, respectively. The differences between the ACP varnish, the TCP varnish, and the water treatments were statistically significant (p < 0.05). CONCLUSION: The ACP varnish formulation delivers statistically significantly more fluoride to both intact and demineralized enamel than the formulation containing TCP.

Thyroid cartilage fracture: treatment with biodegradable plates.

A 29-year-old man fractured his thyroid cartilage while playing rugby. It was treated successfully with an Inion biodegradable plating system. Biodegradable plates are recommended for laryngeal reconstruction.

Petrofilaments in palynological preparations.

Microscopic structures (petrofilaments) may develop during palynological laboratory processing procedures that are superficially similar to secondary wall thickenings and elaters. These filaments form from angular bodies that resemble fungal spores and resin bodies. The angular bodies are a type of hydrocarbon called asphaltene and extrude the filaments when compounds in the bodies react with solvents in the mounting medium. They may be misinterpreted as fossils and so are illustrated here for the first time in the published literature.

Does temporomandibular disorder pain dysfunction syndrome affect dietary intake?

Temporomandibular disorder pain dysfunction syndrome (TDPDS) is the most common cause of facial pain after toothache. The symptoms are varied but are likely to affect the choice, intake and enjoyment of food. This has not been previously investigated. In this paper a preliminary study of 35 patients attending a department of oral and maxillofacial surgery at a general hospital is presented. Thirty-one subjects reported that eating was a problem; 15 prepared food differently and 24 considered that their choice of food was limited. Four of the five foods most often reported to be difficult to eat are valuable in the diet: meat (22), apples (20), bread (13), toast (7) and toffees (6). Twenty-three subjects reported eating a softer diet. Most (25) reported pain when eating. Such circumstances make it harder for TDPDS sufferers to meet current nutritional guidelines, especially, perhaps, for some to achieve an adequate intake of iron.

Laboratory enamel solubility reduction and fluoride uptake from enamelon dentifrice.

The presence of calcium-releasing ingredients in toothpastes containing sodium fluoride is usually avoided to prevent loss of active fluoride due to the formation of the insoluble calcium salt. The purpose of this study was to determine the bio-availability of fluoride from Enamelon Toothpaste (E), which simultaneously supplies fluoride, calcium and phosphate salts from a dual dispensing package. Fluoride uptake into artificially lesioned enamel cores due to the use of the test dentifrice (E) diluted 1:3 in whole human saliva was compared to that from a clinically proven effective sodium fluoride/silica USP reference toothpaste (C) and a non-fluoride control (E-w/o F). Enamel solubility reduction due to the use of E, C and E-w/o F was measured by determining the quantity of phosphate released to lactic acid buffer before and after treatment of the crowns of molars with 1:3 slurries of the dentifrices in water. Fluoride uptakes and enamel solubility reductions were 5031 +/- 158 ppm and 21.6 +/- 2.2% for E, 1915 +/- 39 ppm and 13.6 +/- 2.0% for C, and -3 +/- 2 ppm and 0.8 +/- 1.7% for E-w/o F. The fluoride uptake and enamel solubility reductions from E were significantly greater than from C (p < 0.001, Fisher LSD), and both fluoride-containing dentifrices significantly outperformed E-w/o F (p < 0.001). The laboratory results indicate that the calcium and phosphate salts delivered by the remineralizing Enamelon dentifrice increase the bioavailability of fluoride to substantially exceed that of the clinically proven standard dentifrice.

Remineralization by fluoride enhanced with calcium and phosphate ingredients.

The effectiveness of fluoride ions provided by toothpastes and mouthrinses in promoting remineralization can be limited by the low concentrations of calcium and phosphate ions in saliva. The purpose of this study was to determine whether improved remineralization can be obtained from toothpastes or mouthrinses that simultaneously deliver fluoride, calcium, and phosphate ions from dual-dispensing systems. Enamel specimens with artificial lesions between 60 and 90 microns deep were cycled 15 times through demineralization for 30 minutes, treated for 5 minutes with an experimental or control fluoride toothpaste or mouthrinse, and remineralized for 60 minutes. In the toothpaste study, surface hardness increased by 11.5 +/- 9.2 and 2.7 +/- 3.6 Vickers hardness units, and enamel fluoride content was 5984 +/- 521 ppm and 3971 +/- 531 ppm for the experimental and control fluoride toothpastes, respectively. Remineralization was confirmed by x-ray microradiography. In the mouthrinse study, surface hardness increased by 8.8 +/- 7.7 and 2.2 +/- 3.7 Vickers hardness units, and enamel fluoride content was 6111 +/- 1078 ppm and 3160 +/- 364 ppm for the experimental and control fluoride mouthrinses, respectively. Use of a non-fluoride control mouthrinse led to a decrease in surface hardness of 3.7 +/- 5.2 Vickers hardness units despite a fluoride content of 402 ppm. The results demonstrate that calcium and phosphate supplementation in a toothpaste or mouthrinse can improve remineralization and increase fluoride uptake.

A retrospective survey of patients treated with one-stage (ITI) endosseous implants.

Reports of the success of treatment using endosseous implants vary, and claims about the usefulness of some implant systems are supported by little hard data. The authors of this report followed the progress of patients who had been implanted with the ITI Bonefit implant system over a period of 5 years. They present the results of their study and give recommendations on how general dental practitioners (GDPs) should be trained to use such implants.