Duration of effect of Biotène spray in patients with symptomatic dry mouth: A pilot study.

OBJECTIVES: The objective of this study was to assess the duration of effect of a single dose of Biotène Moisturizing Spray on xerostomia compared to water spray. STUDY DESIGN: This double-blind randomized controlled crossover trial compared the duration of effect of 2 agents on relieving xerostomia in adult patients recruited through convenience sampling. Following a xerostomia questionnaire, qualifying patients with an unstimulated whole saliva flow rate of ≤0.20 mL/min rated their baseline level of discomfort from oral dryness and received a single dose (3 sprays) of Biotène Moisturizing Spray or water (active control). Patients indicated their level of oral discomfort every 15 min and the precise time when relief ceased. After a minimum 48-h washout, patients repeated the exercise with the alternative product. RESULTS: The baseline severity of discomfort from oral dryness among qualifying patients was significantly related to their level of hyposalivation (P = .001). The mean duration of effect of Biotène Moisturizing Spray was 27 ± 25 min, which was not significantly different from that for water (26 ± 25 min; P = .88; n = 25). CONCLUSION: Biotène Moisturizing Spray and water spray had variable durations of effect averaging approximately 30 min. The results of this pilot study provide guidance regarding anticipated usage and dispensing needs for patients with objective xerostomia. ClinicalTrials.gov NCT03663231.

Detailed ultrastructure of the Hirudo (Annelida: Hirudinea) salivary gland.

Medical leeches have been widely used in medical applications and treatments for millennia. Studies on the salivary glands of blood-sucking leeches have focused on their bioactive secretions and mechanisms of action, with little attention to ultrastructure. In this study, we examined dissected embryonic and adult Hirudo verbana salivary glands by scanning electron microscopy (SEM). Gland cells of embryos were physically separated while adults displayed highly developed cell bunches in which each cell was connected to others by fine channels. Channels from each bunch combined to form a larger canal that opened to the jaw. Secreted material from these glands prevent blood from clotting and allow the adult to feed while sucking blood.

Correct spelling of a recently described species of Helobdella (Annelida: Clitellata: Hirudinea).

In a recently published article (Saglam et al. 2018) the name of a new species of Hirudinea (Annelida, Clitellata) was simultaneously published in three different ways, as Helobdella serendipitious (Saglam et al. 2018: 61, 70, 71, 73), Helobdella serendipitous (ibid.: 63, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74), and as Helobdella serendipidous (ibid.: 75). Acting as first reviser according to Article 24 of the International Code of Zoological Nomenclature (ICZN 1999) here we determine serendipitous as the correct spelling of the species epitheton.

Improving oral health-related quality of life for a traumatic brain injury patient: A case report.

AIMS: A preliminary aim was to determine if a patient who had suffered a traumatic brain injury (TBI) could tolerate removal of his remaining teeth and replacement with partially implant-supported prosthetic replacements. The primary aim was to determine if the patient and also his main caregiver could assess a potential change in his oral health-related quality of life. METHODS AND RESULTS: Procedures for the patient were conservative dental restorations, removal of nonrestorable teeth, placement of implants, and fabrication of new dentures. The patient and his primary caregiver, independently, completed the Oral Health Impact Profile-14 (OHIP-14) before and after placement of the implants and Locators. The scores were then compared. The results were that both successfully completed the OHIP-14 and scores showed improvement at 3 and 6 months. CONCLUSION: This is the first report of both, a TBI patient and his primary caregiver independently self-assessing improvement in his quality of life using the OHIP-14 after fabrication of an implant-supported overdenture.

Multidisciplinary dentistry for transitional care patients.

A growing patient population is adolescents and young adults who have had one or more serious medical problems and are aging into adulthood. This group of patients has unique medical needs, which has resulted in the development of a specialized area of medicine: transitional care medicine. The case reviews of two of these patients are described. Patient 1 was a 23-year-old man with hereditary pancreatitis. His genetic condition resulted in the need for pancreatic splenectomy and removal of part of his small bowel, resulting in insulin-dependent diabetes and malnutrition. These complex clinical issues and the challenges of chronic pain were further complicated by severe anxiety disorder and substance abuse. He presented to the University of Rochester Medical Center's Complex Care Center (CCC), an interdisciplinary clinic that provides care for adults with pediatric onset conditions, staffed with both dentists and physicians, with acute pain from a grossly decayed premolar tooth. His blood glucose measured > 500 mg/dL and he was experiencing an acute episode of anxiety. With the expertise and experience of center staff his care needs could be met. Patient 2 was a 32-year-old woman with chronic juvenile rheumatoid arthritis, drug-associated lupus, and mental health problems including depression. This condition requires her to be managed with broad spectrum immunosuppression to prevent joint inflammation that results in significant joint destruction and bone loss. She presented to the CCC with an abscessed molar tooth, which prevented her from receiving her required immunotherapy, IV tocilizamab. While monitored by on-site physicians, a center dentist could safely proceed with the extraction. These cases illustrate that, as the population of transitional care patients grows, general dentists can learn to work on-site with physicians and allied health per-sonnel to meet the need.

Anterior tooth wear and quality of life in a nursing home population.

AIMS: The aim of the study was to assess the extent to which a relationship may exist between the wear of the anterior teeth and quality of life in a population of nursing home residents. METHODS AND RESULTS: A population (n = 100) of nursing home residents (mean age 75.7 years) was recruited all members of which had at least 4 upper and 4 lower anterior teeth and were assessed as cognitively intact by nursing personnel who were familiar with their behavior. The investigator evaluated the level of tooth wear of each subject according to the Tooth Wear Index of Donachie and Walls (Adapted) and then verbally administered the Geriatric Oral Health Assessment Index (GOHAI) of Atchison and Dolan. Analyses did not reveal significant differences in tooth wear between males and females nor between age and GOHAI score; however, tooth wear was positively related to age and inversely related to quality of life. CONCLUSIONS: Results suggest that tooth wear is negatively related to quality of life.

Phylogenetic and morphological resolution of the Helobdella stagnalis species-complex (Annelida: Clitellata: Hirudinea).

The glossiphoniid freshwater leech, Helobdella stagnalis, was described by Linnaeus 1758 based on common European specimens. The presence of a brown, chitinous scute on the dorsal-anterior surface, as observed on leeches elsewhere in the world, has generally led to the classification of all scute-bearing members of the genus as H. stagnalis. Here we describe the morphology and behavior of the type species from Europe, and analyze H. stagnalis-like specimens collected worldwide. We present evidence for at least four distinct scute-bearing Helobdella species that can be morphologically resolved. Maximum Parsimony (MP) and Bayesian Inference (BI) analyses at the mitochondrial cytochrome c oxidase subunit I (COI) locus further supported this notion, with divergence values suggesting a mid-Miocene ancestor of this successful group of cosmopolitan hirudineans. New species, Helobdella echoensis nov. sp., Helobdella eriensis nov. sp., and Helobdella serendipitious nov. sp., are described, based on morphological, anatomical and molecular data. Current distribution patterns of Helobdella spp. suggest a robust, global dispersal mechanism, as well as local pockets of endemism.

Phylogeny and cocoon production in the parasitic leech Myzobdella lugubris Leidy, 1851 (Hirudinidae, Piscicolidae).

Myzobdella lugubris is a commensal leech on crustaceans and a parasite to fishes, surviving predominantly in brackish waters throughout North America. Specimens in this study were collected within the tidal zone of the Delaware River basin (New Jersey and Pennsylvania). To compare regional M. lugubris specimens, defined characters were scored after dorsal and ventral dissections, and phylogenetic relationships were resolved using cytochrome c oxidase subunit 1 (CO1), 12S ribosomal RNA (rDNA) and 18S rDNA gene fragments. Variance between regional populations was low, suggesting recent dispersal events and/or strong evolutionary constraints. The reproductive biology of M. lugubris was explored by quantitative analysis of secreted cocoons. Specimens produced 32.67 ± 4.50 cocoons with fertilization ratios of 88.1% and hatching times of 48 ± 7 days at 17°C under laboratory conditions. At 22°C, 46 ± 28 cocoons were produced with fertilization ratios of 70.27% and hatching times of 28 ± 5 days. Surprisingly, each cocoon supported only one embryo, which is unusual among oligochaetes.

Elaborate ultrastructure of the Hirudo (Annelida: Hirudinae) cocoon surface.

Species of medicinal leeches (Hirudo medicinalis, H. verbana, and H. sulukii) secrete hard-shelled cocoons. When initially deposited, a cocoon is surrounded by a foam. Over a short time, the foam is transformed into a three-dimensional structure. We show here that this peripheral structure likely forms by the solidification and dehydration of a moderately viscous, proteinaceous substance that surrounds bubbles of various sizes. The resulting matrix-like structure comprises a network of curved branches juxtaposed at ∼120° and taper in width as a function of distance from the outer cocoon wall. The material is proteinaceous, and traps environmental material in its composition, especially silicon. The geometry of compartments and abundance of silicon on branch surfaces suggest a mechanism for trapping water to prevent desiccation in a terrestrial environment.

Management of persistent lingual angioedema: a team approach.

A 70-year-old African American man suffered anoxic encephalopathy following a choking episode. He had a history of hypertension, which was being treated with lisinopril, an angiotensin-converting enzyme inhibitor (ACEI). Soon after the patient's admission to an intensive care unit, his tongue began to swell until it reached more than twice its normal size and extended almost 2 inches outside his mouth. When the swelling did not diminish after 2 weeks, a diagnosis of ACEI-induced angioedema was determined. ACEIs have the potential to cause angioedema through an uncommon effect on the angiotensin-renin vascular control system. Lingual angioedema can be life-threatening due to the possibility of severe compromise of the airway and thus may require immediate intubation. After the ACEI is discontinued, swelling may remain if there is continued pressure from the maxillary and mandibular incisors on the dorsal and lingual surfaces of the tongue. In this case, the patient was comatose and unable to voluntarily move the tongue; therefore, relief from pressure was easily accomplished, and the edema was eventually diminished through a team effort in which a dentist instructed the nursing personnel on proper placement of Molt mouth props.

Partial denture swallowed by patient with dementia.

PURPOSE: To present a rare case of a male dementia patient in a nursing home who swallowed a partial denture which lodged in the airway. METHODS: During breakfast, a patient with moderate dementia experienced a sore throat, labored breathing, and difficulty swallowing. Uncertainty about the cause of these problems was exacerbated by the patient's cognitive losses, his reduced oro-motor function, and awareness of caregivers that the possible involvement of a denture of this size was unlikely. At the beginning of the third day, he developed a low-grade fever and was placed on antibiotics. A chest x-ray was negative. RESULTS: On the fourth day, a flexible endoscopic evaluation of swallowing was performed, which revealed the partial denture resting in the hypopharynx on the patient's vocal cords. DISCUSSION: Along with pneumonia and viral bronchitis, a swallowed denture needs to be in the differential diagnosis of a dementia patient experiencing difficulty swallowing. CONCLUSIONS: Nursing home caregivers be aware that even a sizable partial denture can be swallowed and extra vigilance is essential in caring for dementia patients.

Historical biogeography of the North American glacier ice worm, Mesenchytraeus solifugus (Annelida: Oligochaeta: Enchytraeidae).

North American ice worms are the largest glacially-obligate metazoans, inhabiting coastal, temperate glaciers between southcentral Alaska and Oregon. We have collected ice worm specimens from 10 new populations, completing a broad survey throughout their geographic range. Phylogenetic analyses of 87 individuals using fragments of nuclear 18S rRNA, and mitochondrial 12S rRNA and cyctochrome c oxidase subunit 1 (CO1) identified 18 CO1 haplotypes with divergence values up to ~10%. Phylogeographic interpretations suggest a St. Elias Range, Alaskan ancestry from an aquatic mesenchytraeid oligochaete during the early-Pliocene. A gradual, northward expansion by active dispersal from the central St. Elias clade characterizes a northern clade that is confined to Alaska (with one exception on Vancouver Island, British Columbia), while a distinct southern clade representing worms from British Columbia, Washington and Oregon was likely founded by a passive dispersal event originating from a northern ancestor. The geographic boundary between central and southern clades coincides with an ice worm distribution gap located in southern Alaska, which appears to have restricted active gene flow throughout the species' evolutionary history.

Perceptions of dental esthetics among older African Americans.

Older adults have greater potential for issues with the appearance of their teeth than other age groups. Conditions including missing teeth, fractured or missing restorations, and excessive tooth wear are common and may potentially affect individuals' perceptions of their dental esthetics. These perceptions about dental conditions may be significant because previous research suggests that they may impact elders' quality of life. The purpose of this study was to investigate the esthetic ranking of specific dental conditions by a population of African American elderly, utilizing methods similar to those of an earlier study of older Caucasians. These methods were designed to determine whether specific oral/facial and dental conditions were associated with similar perceptions of esthetics in a series of computer-adjusted images regardless of gender or any other facial characteristics. Our results suggest that, among the conditions studied, perceptions of dental esthetics of elderly African Americans were similar to those of Caucasians.

Factors associated with oral health-related quality of life in community-dwelling elderly persons with disabilities.

OBJECTIVES: To examine, in community-dwelling elderly persons with disabilities, the association between oral health-related quality of life (OHRQOL) as measured using the 14-item Oral Health Impact Profile (OHIP-14) and specific oral health, health, and disability status variables; life satisfaction; living alone; and low income. DESIGN: Observational cross-sectional. SETTING: A Medicare demonstration conducted in 19 counties in three states. PARTICIPANTS: Six hundred forty-one disabled, cognitively intact, community-dwelling individuals aged 65 and older. MEASUREMENTS: The subjects' OHRQOL was assessed using the OHIP-14, which was scored using three different methods. Data on oral health, health and functional status, life satisfaction, prior health services use, and sociodemographics were collected using interviewer-administered questionnaires. RESULTS: The participants' mean age was 79.1, and they were dependent in an average of 1.8 activities of daily living (ADLs); 43.1% were edentulous, 77.4% wore a denture, 40.4% felt that they were currently in need of dental treatment, and 64.7% had not had a dental examination in the previous 6 months. Seven of the 16 variables of interest had significant bivariate relationships using three OHIP scoring methods. Logistic regression analysis found that poor OHRQOL was significantly associated with perceived need for dental treatment (odds ratio (OR)=2.61), poor self-rated health (OR=2.29), poor (OR=2.00) and fair (OR=1.73) mental health, fewer than 17 teeth (OR=1.74), and relatively poor cognitive functioning (OR=1.52). CONCLUSION: OHRQOL is associated with some (perceived need for dental treatment, poor self-rated health, worse mental health, fewer teeth, and relatively poor cognitive status) but not all (e.g., ADL and instrumental ADL dependence) measures of oral health, health, and disability status and not with life satisfaction, living alone, or low income.

Oral health conditions of community-dwelling cognitively intact elderly persons with disabilities.

OBJECTIVES: To present descriptive information on oral health and health care of community-dwelling elderly persons with disabilities who are living at home. BACKGROUND: Most previous studies have focused on specific subpopulations, namely, persons who are essentially healthy and independent, are homebound, or are nursing home residents. Little information appears to be available on community-residing elderly persons with disabilities. MATERIALS AND METHODS: A total of 641 participants aged 65 years and over in a Medicare Demonstration who were cognitively intact, completed an oral health questionnaire within 1 year of Demonstration entry. Demonstration participants were required to be living in the community, need or receive help with 2+ activities of daily living (ADLs) or 3+ instrumental ADLs (IADLs), and have recently experienced significant health services utilisation. RESULTS: Subject mean age was 79.1 years, 73.8% were female, and 4% were minority. They were dependent in a mean of 1.8 ADLs and 2.9 IADLs. 43.1% reported that they had no natural teeth, 77.4% had dentures, 58.8% frequently felt their mouth was dry, 5.2% had jaw pain now and 6.1% had at some time experienced burning sensations in their mouth or tongue. 40.4% reported that they were currently in need of dental treatment, although 56.2% indicated they now had a dentist, and 42.1% identified having a dental visit within the past 12 months. 19.7% indicated some dental insurance coverage. CONCLUSION: This is one of the first studies to focus on community-dwelling elderly people with disabilities. Substantial oral health morbidity was reported.