Health-related quality of life in patients with polycystic ovary syndrome: validation of the German PCOSQ-G.

PURPOSE: Patients with polycystic ovary syndrome (PCOS) report a decreased health-related quality of life (HRQOL) and higher levels of psychological distress. Validated questionnaires are necessary to assess the impact of PCOS on patients' lives. The aim of the present study was to evaluate the German "Polycystic Ovary Syndrome Questionnaire" (PCOSQ-G). METHODS: The psychometric properties of the PCOSQ-G were investigated in PCOS patients with item-total correlation, internal consistency and test-retest reliability. Correlations with the Short-Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS-D) were calculated to evaluate the validity of the PCOSQ-G. Discriminatory validity was investigated through a receiver operating characteristic curve and independent sample t tests compared with healthy controls. RESULTS: Good psychometric properties were found for most items. Acceptable to high internal consistency was found for the total score (α = 0.94-0.95) and all subscales (α = 0.70-0.97). High test-retest reliability was found for the total score (0.86) and all subscales (0.81-0.90). The validity analyses showed that the PCOSQ-G total score was positively correlated with both SF-36 summary scales and was negatively correlated with both HADS subscales. Patients reported significantly lower values for the PCOSQ-G total score (p < 0.001) and all subscales, and the PCOSQ-G discriminated well between patients and healthy controls (AUC = 0.81, p < 0.001). CONCLUSIONS: PCOSQ-G is a reliable and valid tool to assess the HRQOL in patients with PCOS and can be used in future clinical research. Patients with PCOS exhibited an impaired HRQOL, which indicates the need for psychosomatic counseling.

[Delusion and Gender in Paranoid Schizophrenia: Results of a Clinical Study]. / Wahn und Geschlecht bei paranoider Schizophrenie: Befunde aus einer klinischen Stichprobe.

Aim: The aim of the present study was to investigate whether men and women differ in the frequency and phenomenology of delusions. Sample: Medical records of all patients who had been admitted to a psychiatric hospital in Germany between 2008 and 2011 for paranoid schizophrenia were analyzed. The sample consisted of 182 delusional inpatients (90 women, 92 men) with the diagnosis of a paranoid schizophrenia. Results: Men and women did not differ in the frequency of delusional themes. Analysis of delusional content, however, revealed considerable differences between them. Women with delusion of reference felt more often as being under constant surveillance compared to men. Men with delusion of reference showed a tendency to involve unspecified persons in their delusions and more often had the feeling of being talked about. Delusion of grandeur in women was more often built upon significant relationships with others.

Outcomes of direct pulp capping: interrogating an insurance database.

AIM: To evaluate the effectiveness of direct pulp capping under general practice conditions. It was hypothesized that direct pulp capping is an effective procedure in the majority of cases and prevents the need for root canal treatment or extraction. METHODOLOGY: Claims data were collected from the digital database of a major German national health insurance company. Only patients who had been insurance members for the entire 3 year period 2010 to 2012 were eligible. Kaplan-Meier survival analyses were conducted for all teeth with direct pulp capping. Success was defined as not undergoing root canal treatment. Survival was defined as not undergoing extraction. Differences between survival functions were tested with the log rank test. RESULTS: A total of 148 312 teeth were included. The overall success rate was 71.6% at 3 years. The overall survival rate was 95.9% at 3 years. The success rates for single-rooted teeth (71.8%) and multirooted teeth (71.5%) were similar although significantly different (P < 0.001). Best 3-year success rates were found at low (79.7%; <18 years.) and very high age (81.8%; >85 years.). CONCLUSIONS: After direct pulp capping, more than two-thirds of the affected teeth did not undergo root canal treatment within 3 years. Although this study has the typical limits of a claims data analysis, it can be concluded that direct pulp capping is an effective intervention to avoid root canal treatment and extraction in a general practice setting.

Management of shortened dental arches and periodontal health: 5-year results of a randomised trial.

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2-1 to 2-6, WO 677/2-1.1 to 2-2.1.; controlled-trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre-molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior-most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL-V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL-V and PPD, significant differences were also found for the study jaw as a whole. For CAL-V, the estimated group differences over 5 years amounted to 0.27 mm (95% CI 0.05; 0.48; P = 0.016) for the study jaw and 0.25 mm (95% CI 0.05; 0.45; P = 0.014) for the distal sites of the posterior-most teeth. The respective values for PPD were 0.22 mm (95% CI 0.03; 0.41; P = 0.023) and 0.32 mm (95% CI 0.13; 0.5; P = 0.001). It can be concluded that even in a well-maintained.patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.

The randomized shortened dental arch study: oral health-related quality of life.

OBJECTIVES: Although the shortened dental arch (SDA) concept is a widely accepted strategy to avoid overtreatment, little is known on its impact on oral health-related quality of life (OHRQoL). This multicenter randomized controlled trial aimed to investigate the OHRQoL for removable partial dental prostheses (RPDP) with molar replacement versus the SDA concept. MATERIAL AND METHODS: In both groups, missing anterior teeth were replaced with fixed dental prosthesis. Two hundred fifteen patients with bilateral molar loss in at least one jaw were included. The Oral Health Impact Profile (OHIP-49) was completed before; 6 weeks (baseline), 6 months, and 12 months after treatment; and thereafter annually until 5 years. RESULTS: Of the initial cohort, 81 patients were assigned to the RPDP group and 71 to the SDA group (age, 34 to 86 years). Before treatment, the median OHIP score was similar in both groups (RPDP, 38.0; SDA, 40.0; n.s.). Results indicate marked improvements in OHRQoL in both groups between pretreatment and baseline (RPDP, 27.0; SDA, 19.0; p ≤ 0.0001) which continued in the RPDP group until the 1-year follow-up (p = 0.0002). These significant reductions in OHIP scores are reflected in its subscales. No further differences were seen within and between groups during the remainder observation period. CONCLUSION: Both treatments show a significant improvement in OHRQoL which continued in the RPDP group until the 1-year follow-up. No significant differences were seen between groups. CLINICAL RELEVANCE: For improving OHRQoL, it is not necessary to replace missing molars with a RPDP.

The randomized shortened dental arch study: tooth loss over five years.

OBJECTIVES: The study was designed to provide clinical outcome data for two treatments of the shortened dental arch (SDA). MATERIAL AND METHODS: In a multicenter randomized controlled clinical trial, patients with complete molar loss in one jaw were provided with either a partial removable dental prosthesis (PRDP) retained with precision attachments or treated according to the SDA concept preserving or restoring a premolar occlusion. No implants were placed. The primary outcome was tooth loss. RESULTS: Of 152 treated patients, 132 patients reached the 5-year examination. Over 5 years, 38 patients experienced tooth loss. For the primary outcome tooth loss, the Kaplan-Meier survival rates at 5 years were 0.74 (95% CI 0.64, 0.84) in the PRDP group and 0.74 (95% CI 0.63, 0.85) in the SDA group. For tooth loss in the study jaw, the survival rates at 5 years were 0.88 (95% CI 0.80, 0.95) in the PRDP group and 0.84 (95% CI 0.74, 0.93) in the SDA group. The differences were not significant. No Cox regression models of appropriate fit explaining tooth loss on the patient level could be found. CONCLUSIONS: The overall treatment goals of a sustainable oral rehabilitation and the avoidance of further tooth loss over longer periods were not reliably achievable. The influence of the type of prosthetic treatment on tooth loss might have been overestimated. CLINICAL RELEVANCE: Regarding our results, the patient's view will gain even more importance in the clinical decision between removable and fixed restorations in SDAs.

The randomized shortened dental arch study: 5-year maintenance.

The scientific evidence concerning prosthodontic care for the shortened dental arch (SDA) is sparse. This randomized multicenter study aimed to compare two common treatment options: removable partial dental prostheses (RPDPs) for molar replacement vs. no replacement (SDA). One of the hypotheses was that the follow-up treatment differs between patients with RPDPs and patients with SDAs during the 5-year follow-up period. Two hundred and fifteen patients with complete molar loss in one jaw were included in the study. Molars were either replaced by RPDPs or not replaced according to the SDA concept. A mean number of 4.2 (RPDP) and 2.8 (SDA) treatments for biological or technical reasons occurred during the 5-year observation time per patient. Concerning the biological aspect, no significant differences between the groups could be shown, whereas treatment arising from technical reasons was significantly more frequent for the RPDP group. When the severity of treatment was analyzed, a change over time was evident. When, at baseline, only follow-up treatment with minimal effort is required, over time there is a continuous increase to moderate and extensive effort observed for both groups (Controlled-trials.com number ISRCTN97265367).

[Preventive strategies in prosthetic dentistry]. / Präventionsorientierte Strategien in der prothetischen Zahnmedizin.

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

The randomized shortened dental arch study: tooth loss.

The evidence concerning the management of shortened dental arch (SDA) cases is sparse. This multi-center study was aimed at generating data on outcomes and survival rates for two common treatments, removable dental prostheses (RDP) for molar replacement or no replacement (SDA). The hypothesis was that the treatments lead to different incidences of tooth loss. We included 215 patients with complete molar loss in one jaw. Molars were either replaced by RDP or not replaced, according to the SDA concept. First tooth loss after treatment was the primary outcome measure. This event occurred in 13 patients in the RDP group and nine patients in the SDA group. The respective Kaplan-Meier survival rates at 38 months were 0.83 (95% CI: 0.74-0.91) in the RDP group and 0.86 (95% CI: 0.78-0.95) in the SDA group, the difference being non-significant.

Intrapyloric injection of botulinum toxin a for the treatment of persistent gastroparesis following successful pancreas transplantation.

Intrapyloric injection of botulinum toxin A (BoTx) successfully improved symptoms in idiopathic and diabetic gastroparesis (DGP) refractory to medical treatment. Therefore, we used it in three pancreas transplant patients done in our institution during the last 18 months. They had severe, persistent DGP despite successful pancreas transplantation. They received 100 units of BoTx during the first injection. The clinical effect became evident within 2 weeks after the treatment, and lasted for an average of 29 weeks (range 14-44 weeks). The patients' subjective evaluation showed improvement of their symptoms and quality of life following BoTx. Patients 2 and 3 had recurrent symptoms at 44 and 24 weeks, respectively, after the first injection; they required a second dose of 90 and 80 units, respectively. They are doing well at 3 months follow-up. Intrapyloric injection of BoTx is safe and efficient. It should be considered for treating residual DGP following successful pancreas transplantation.

Prosthetic treatment need in a representative German sample.

Regarding declining resources epidemiological data on needs for oral rehabilitation are required. Within the framework of an oral health survey a non-stratified two-stage random sample was taken to represent the over 14-year-old population of Saxony/Germany. The participation rate was 55%. Normative need was determined by dental assessment and guidelines developed in a consensus process, subjective prosthetic treatment need by self-complete questionnaire. About 97% of the realized sample could be planned within the guidelines. About 81% had normative prosthetic treatment need. Compared with the rate of normative need the rate of subjective need (13%) was considerably lower (chi(2) P < 0;01). Different predictive parameters of subjective need were identified by logistic regression. Besides other factors subjective need was associated with giving dentist's recommendation as significant reason for prosthetic restorations [odds ratio (OR)=5;43], not believing that the own teeth were all right (OR=0;17), and the existence of prosthetic restorations (OR=3;87 for fixed restorations; OR=4;05 for removable dentures). The guidelines proved their suitability to assess normative prosthetic treatment need in oral health surveys. Further research is necessary to find adequate options for including patients' preferences in an adequate need definition.

Multivariate analysis of oral hygiene data from a representative sample.

BACKGROUND: This analysis was based on an oral health survey with dental examination and interview by questionnaire. METHOD: The data set comprised a representative random sample of the over 14-year-old residents of the German Federal State of Saxony (n=714), in which a multivariate logistic regression analysis was conducted. The dependent variable was the debris index (DI) score of the oral hygiene index scoring system. The subjects were split into 2 groups by dividing DI scores into tertiles: those with acceptable oral hygiene (1st tertile, DI 0.00< or =1.20) and unacceptable oral hygiene (2nd and 3rd tertile, DI>1.20). The most important explanatory variable was the community periodontal index of treatment need (CPITN). RESULTS: The higher the CPITN score, the lower the probability of acceptable oral hygiene. In relation to the reference category score 0, higher CPITN scores were associated with acceptable oral hygiene, with an odds ratio 0.05 (95% confidence interval (CI)=0.01-0.23) for CPITN score 1, and an odds ratio 0.02 (95% CI: 0.01-0.08) for score 4. Further significant variables were: self-evaluation of tooth condition, gender, and the number of missing teeth.

Plaque, gingival health and post-operative sensitivity in titanium inlays and onlays: a randomized controlled clinical trial.

OBJECTIVES: Few clinical data on the use of titanium for restorative appliances are available. The aim of this study was to clinically evaluate titanium restorations compared to gold alloy restorations with regard to plaque, gingival health and post-operative sensitivity. METHODS: In 54 patients, 99 titanium restorations were placed. The control group comprised 56 patients with 96 high gold alloy restorations. The material was chosen by random. Each patient received one or two Class II restorations. Plaque Index (Silness and Löe, 0-3), Gingival Index (Löe and Silness, 0-3), and post-operative sensitivity (1-4, 1=none) were rated at 2 weeks, 3 months, 6 months, 12 months, and 18 months, post-operatively. RESULTS: The mean plaque scores ranged from 0.89 to 0.99 in the titanium group, and from 0.88 to 1.04 in the gold group. The mean gingival scores ranged from 0.91 to 1.07 in the titanium group, and from 0.82 to 0.99 in the gold group. The mean plaque and gingival scores of the titanium and gold group did not differ significantly at any visit (P>0.05). To evaluate post-operative sensitivity, patients with one MOD restoration each were included, resulting in 46 titanium and 44 high gold restored teeth. Mean values of the post-operative sensitivity scores in the titanium group were significantly higher than in the gold group (P<0.05). The restoration material was found to be the dominating variable with regard to post-operative sensitivity, which was not influenced by age, sex and the application of calcium hydroxide liner. CONCLUSIONS: It is concluded that neither higher plaque scores nor adverse effects on gingival health are to be expected in titanium restorations.

[Patients' need for information before surgery]. / Aufklärungsbedürfnisse chirurgischer Patienten.

Frequently, prior to surgery, patients are provided with information in order to meet legal and hospital requirements, but without taking their psychological needs into consideration. In order to learn how to improve this situation, the present study was performed. By means of a semi-structured interview including a newly constructed card system, that avoids giving patients undemanded and possibly harmful implicit information, the need for information of 60 patients before hip- or knee-replacement surgery were investigated in great detail. The results show that 83.3% of the patients want to be prepared by the surgeon, preferably by means of an oral communication (75.0%). Most frequently the day when decision for surgery is made and the day of hospitalization were preferred as point of time for preparation (30% each). Patients were more interested in information about the operation and recovery (43.3% each) than about risks (33.3%). Only 11.7% wanted to get psychological preparation prior to surgery. We conclude that coming into contact and establishing a trustful relationship with the surgeon who does the operation is the most crucial need of surgical patients. He should give presurgical information according to the patient's needs, which often do not focus on the risks, as legal regulations do. By providing psychological preparation for the small number of patients in need, psychological specialists may contribute to improve satisfaction and outcome of surgical patients.

Burs with guide pins for standardized tooth preparation.

OBJECTIVE: The aim of this study was to develop and test self-limiting diamond burs to ease precise chamfer preparation and to fulfill the special requirements of computer-aided design/computer-aided manufacturing and all-ceramic restorations. METHOD AND MATERIALS: Rounded cylinder (based on ISO 881) and torpedo (based on ISO 879) diamond burs with a polished guide pin, 0.5 mm in length and 0.15 mm in radius, at the front end were developed in cooperation with an industrial partner. The in vitro testing involved a total of 140 human teeth. Experimental variables were the quality of the finish line, the microhardness of the enamel, and the thermal alteration of the dentin. Conventional diamonds served as a control. RESULTS: No mechanical or thermal damage related to the bur design was found in the hard tissues that had potentially been in contact with or in close proximity to the guide pin. Microhardness of the enamel at the finish line was significantly higher when prepared with burs with a guide pin compared to conventional burs. The results of using the guide pin might indicate the beneficial effect of reduced vibration. CONCLUSION: The guide pins of the self-limiting diamond burs reduce, rather than increase, the risk of hard tissue damage at the preparation margin. No adverse effects were found. Clinical use is justified.

Accuracy of mechanical digitizing with a CAD/CAM system for fixed restorations.

PURPOSE: Most research on the accuracy of dental computer-aided design/manufacturing (CAD/CAM) systems focuses on the marginal gap. A detailed analysis of the various components of CAD/CAM systems (digitizer, software, and milling machine) using this approach is nearly impossible. The purpose of this study was to determine the accuracy of the manual mechanical digitizer of the Precident-DCS system. MATERIALS AND METHODS: Gauge blocks were aligned to the coordinate planes of the digitizer to determine the point and length measurement uncertainty. The values for each measuring point were compared for statistical differences concerning first versus second operator, pressure, and mode of sensing using analysis of variance. The measurement uncertainty was given by 95th percentiles. RESULTS: The mean one-dimensional point measurement uncertainty in the Y direction was 11 microm for the first, 8 microm for the second, and 37 microm for both operators. The three-dimensional point measurement uncertainty in the Y direction was 10 microm for the first, 33 microm for the second, and 60 microm for both operators. The point measurement uncertainty was significantly influenced by the pressure during sensing and by the operator as well. There were significant differences between the first and second recordings. The length measurement uncertainty in the Y direction for a gauge block of 20 mm was 52 microm for both operators. CONCLUSION: The reliability of the manually guided Precident-DCS digitizer is limited because of the significant influence of the operator and the mode of sensing (one or three dimensional). Compared with an automatic digitizing system, the measurement uncertainty of the manually guided digitizer exceeds the values published in the literature.

Clinical fit of Procera AllCeram crowns.

STATEMENT OF PROBLEM: Color stability, strength, and accuracy of fit are the main requirements for complete-ceramic crowns. The Procera AllCeram crown system is a CAD/CAM system used to fabricate individual complete-ceramic crowns that have a dry sintered, aluminum oxide core and appear to match clinical requirements. However, there are few articles about the clinical fit of all-ceramic crowns. PURPOSE: This in vivo study measured the accuracy of fit of Procera AllCeram crowns in anterior and posterior teeth. MATERIAL AND METHODS: The clinical fit of 80 anterior and posterior Procera AllCeram crowns was evaluated by a replica technique with a light body silicone to fill space between crown and tooth and a heavy body silicone to stabilize the light body film. After removal from the artificial crowns, the replicas were segmented, and measurements of the film thickness were performed with a light microscope. RESULTS: Medians of mean marginal gap widths were between 80 and 95 microm in anterior teeth and between 90 and 145 microm in posterior teeth. Medians of maximal marginal gap widths ranged from 80 to 180 microm in anterior teeth and from 115 to 245 microm in posterior teeth. CONCLUSION: The accuracy of fit achieved by Procera AllCeram was comparable to other conventional and innovative systems.

Arbuscular mycorrhizal fungi induce the non-mevalonate methylerythritol phosphate pathway of isoprenoid biosynthesis correlated with accumulation of the 'yellow pigment' and other apocarotenoids.

Plants and certain bacteria use a non-mevalonate alternative route for the biosynthesis of many isoprenoids, including carotenoids. This route has been discovered only recently and has been designated the deoxyxylulose phosphate pathway or methylerythritol phosphate (MEP) pathway. We report here that colonisation of roots from wheat, maize, rice and barley by the arbuscular mycorrhizal fungal symbiont Glomus intraradices involves strong induction of transcript levels of two of the pivotal enzymes of the MEP pathway, 1-deoxy-D-xylulose 5-phosphate synthase (DXS) and 1-deoxy-D-xylulose 5-phosphate reductoisomerase (DXR). This induction is temporarily and spatially correlated with specific and concomitant accumulation of two classes of apocarotenoids, namely glycosylated C13 cyclohexenone derivatives and mycorradicin (C14) conjugates, the latter being a major component of the long-known 'yellow pigment'. A total of six cyclohexenone derivatives were characterised from mycorrhizal wheat and maize roots. Furthermore, the acyclic structure of mycorradicin described previously only from maize has been identified from mycorrhizal wheat roots after alkaline treatment of an 'apocarotenoid complex' of yellow root constituents. We propose a hypothetical scheme for biogenesis of both types of apocarotenoids from a common oxocarotenoid (xanthophyll) precursor. This is the first report demonstrating (i) that the plastidic MEP pathway is active in plant roots and (ii) that it can be induced by a fungus.

Clinical significance of surface activation of silicone impression materials.

OBJECTIVES: Surface activation of silicone impression materials enhances impression accuracy as well as the quality of stone casts. This study examined the relation between impression quality and the hydrophilicity of silicone impression materials used in a two-stage putty and wash technique. METHODS: The study included 14 silicone impression materials with and without surface activation. The contact angles of the light body materials were measured using deionised water. Free surface energies were calculated. A total of 140 impressions of wet intact permanent molar teeth were examined for definition of the gingival sulcus reproduction and then classified in a quality ranking. The percentage of the sulcus reproduction ability of each material was calculated from the sulcus depths of cross-sectioned resin casts from the impressions and clinically measured sulcus depths. RESULTS: Free surface energies (mJ/m2) of hydrophobic materials (contact angle > 90 degrees) ranged from 16.8 to 26.8 mJ/m2. Surface activated materials (contact angle < 90 degrees) exhibited free surface energies from 38.1 to 55.7 mJ/m2. Not all materials described as surface activated showed hydrophilic properties. Medians of impression quality ranking ranged from 1.75 (best) to 13.25 (worst), mean sulcus reproduction ranged from 30 to 52%. Significant differences (P < 0.05) in quality ranking and sulcus reproduction were found between certain materials but correlations were found neither between sulcus reproduction and free surface energy nor between quality ranking and free surface energy. CONCLUSIONS: For clinical impression recording, surface activation seems to be of minor relevance, at least in the two-stage putty and wash technique investigated and is superimposed by other material properties.