[Is there more to hypodontia then missing teeth?] / Ernstige hypodontie: meer dan alleen ontbrekende gebitselementen?

Dental care professionals regularly see patients with hypodontia. Hypodontia can be acquired, for example through chemotherapy or radiation at a young age, but is hereditary in most patients. Due to an error (pathogenic variant) in one of the many genes that control odontogenesis, the formation of the tooth germ is disrupted at an early stage. The genes involved are not only crucial for tooth development, but they also play an important role in other physical processes. This article provides background information on hypodontia. Based on an inventory of gastrointestinal complaints in patients with hypodontia and a case description of the simultaneous occurrence of a coagulation disorder and hypodontia, the importance of a broad view of this patient group is illustrated. It is concluded that, in addition to a dental assessment, examination of these patients should include a limited physical examination and the medical history of the patient and his close relatives.

[Disease burden of extreme treatment anxiety; quality of life for patients with and without extreme dental treatment anxiety]. / Ziektelast en kwaliteit van leven bij patiënten met en zonder extreme angst voor tandheelkundige behandelingen.

In this study, a comparison was made between disease-specific (oral health-related) quality of life (OHQoL), measured with the OHIP-14 questionnaire, and generic (general health-related) quality of life (GHQoL), measured with the EQ5D-5L questionnaire, in patients with and without extreme dental treatment anxiety. A total of 76 patients who could not be treated due to extreme dental treatment anxiety were referred to a centre for special dentistry. These patients were matched, according to age, gender and socioeconomic status, with participants in an epidemiological study on oral health (n = 1125). Wilcoxon signed-rank tests were used on both groups to compare GHQoL and OHQoL. The total OHIP score was higher (representing a lower quality of life) in the patient group than in the control group. Anxiety patients scored higher on all 7 domains of the OHIP-14. With respect to general quality of life, patients with extreme treatment anxiety were found to report lower utility scores than the matched control group. With these results, a total disease burden of 74,000 disability-adjusted life years (DALYs) was calculated for extreme treatment anxiety in the Netherlands. The findings of this study reveal that having extreme dental treatment anxiety results in a significant disease burden in the Netherlands.

The burden of disease of dental anxiety: generic and disease-specific quality of life in patients with and without extreme levels of dental anxiety.

The aim of this study was to compare disease-specific (oral health-related) quality of life (OHRQoL), assessed using the Oral Health Impact Profile-14 (OHIP-14), and generic (health-related) quality of life (HRQoL), assessed using the EuroQol5D (EQ-5D-5L), in patients with severe dental anxiety (who were visiting a centre for special care dentistry) with a control group from the general population. Seventy-six patients with severe dental anxiety [Dental Anxiety Scale (DAS) score ≥ 13] were matched, according to age, gender, and socio-economic status, to a control group of 76 participants in a larger epidemiological study on oral health in the Netherlands (n = 1,125). The Wilcoxon signed-rank test was used to compare levels of HRQoL and OHRQoL in both groups. The total OHIP score (indicating lower OHRQoL) was higher for the patient group (10th percentile = 30.5; 90th percentile = 46.0) than for the control group (10th percentile = 1.0; 90th percentile = 14.5). The patient group showed higher scores on all seven OHIP domains. Lower utility scores were found in patients with severe dental anxiety (HRQOL: 10th percentile = 0.7; 90th percentile = 0.9) relative to the control group (HRQOL: 10th percentile = 0.9; 90th percentile = 1.0). A disease burden of 74,000 disability-adjusted life years (DALYs) was calculated for the Netherlands. The findings of this study show differences between patients visiting a dental fear clinic and matched controls from the general population for both OHRQoL and HRQoL, indicating that having severe dental anxiety generates a significant burden of disease.

Cardiogenic shock induced by cocaine in swine with normal coronary arteries.

OBJECTIVE: The aim was to test the hypothesis that acute intravenous cocaine administration can cause coronary microvascular constriction culminating in myocardial ischaemia and cardiogenic shock. METHODS: Systemic haemodynamic variables and coronary blood flow were measured in 14 Yorkshire swine at baseline and following intravenous administration of 1, 3, and 10 mg.kg-1 of cocaine. Epicardial coronary artery diameter was measured from coronary arteriograms and coronary flow velocity was recorded with a Doppler flow wire. RESULTS: Cocaine produced a decrease in mean arterial pressure (65%), cardiac output (80%), and stroke volume (80%), and an increase in pulmonary artery diastolic pressure (60%). Although coronary blood flow decreased by 70%, epicardial coronary cross sectional area decreased by only 37-45%. Pretreatment with prazosin did not abolish the decrease in coronary blood flow. After administration of 10 mg.kg-1 of cocaine, five of 14 animals developed myocardial ischaemia and cardiogenic shock, culminating in ventricular fibrillation and death. CONCLUSIONS: In anaesthetised Yorkshire swine, cumulative intravenous doses of cocaine caused a significant reduction in coronary blood flow resulting in myocardial ischaemia, which cannot be attributed to epicardial vasoconstriction alone. This suggest that cocaine-induced coronary ischaemia may result from microvascular constriction, which is only partially prevented by alpha 1 blockade. In addition, direct toxic effects of cocaine on the myocardium may also contribute to the development of cardiogenic shock.

Quantification of thallium-201 scintigrams in acute myocardial infarction.

A method has been developed for measurement of myocardial infarct size from thallium-201 scintigrams that depends on computer measurement of levels of radioactivity in the myocardium. In 16 dogs, thallium-201 scintigrams were obtained in the left lateral and left anterior oblique projections 48 hours after ligation of the left anterior descending coronary artery. Scintigraphic results were obtained by two independent observers and were compared with tissue measurements of infarct volume calculated from thallium autoradiograms and nitro-blue tetrazolium (NBT)-stained tissue slices. Infarct volumes derived from tissue measurements were used to develop criteria for the computer scintigraphic technique. There was no significant difference in the scintigraphic measurements made by the two observers. Scintigraphic infarct size in the left lateral and left anterior oblique projections correlated with tissue infarct size with r values of 0.88 and 0.75, respectively, for thallium autoradiography and 0.71 and 0.70, respectively, for NBT tissue staining. The range of infarct volume was 3.3 to 14.8 percent of the left ventricular mass. Results of this study suggest that scintigraphic quantitation of infarct size is feasible in this dog model.

Cocaine-induced microvascular vasoconstriction but differential systemic haemodynamic responses in Yucatan versus Yorkshire varieties of swine.

1. Systemic and coronary haemodynamics were measured in 6 Yorkshire swine and 6 Yucatan miniature swine under isoflurane anaesthesia to investigate the influence of cocaine following its intravenous administration at 1, 3 and 7 mg kg-1. 2. Cocaine in Yorkshire swine decreased mean arterial pressure and rate pressure product (systolic pressure x heart rate), suggesting a cardiac depressant effect, whereas cocaine in Yucatan miniature swine increased these parameters, consistent with a hyperadrenergic state. 3. Cocaine in both Yorkshire swine and Yucatan miniature swine decreased coronary blood flow and coronary flow reserve, and increased coronary vascular resistance. 4. A modest generalized epicardial coronary artery constriction was observed by angiography, without evidence of focal spasm. 5. Our results confirm a marked vasoconstrictor effect of cocaine on the coronary arterial circulation, predominantly distal to the epicardial coronary arteries, but also indicate important differences in the systemic cardiovascular responses to the drug between two closely related strains of animals within the same species. Due to the similarities between the swine and human coronary arterial vasculature, we suggest that vasoconstriction in the coronary microcirculation may produce cardiac toxicity in man.

Quantification of myocardial ischemia and infarction with 201thallium scintigraphy.

A quantitative method for the analysis of 201thallium myocardial scintigrams, developed in an experimental infarcted dog heart model, has been compared with two nonquantitative methods for interpretation of stress myocardial scintigrams in two groups of patients studied with coronary angiography: 11 with normal coronary arteries and 14 with coronary artery disease. Three independent observers interpreted scintigrams which were 1) not computer processed; 2) corrected for background activity in lungs and chest wall; and 3) processed by a computer method which uses a uniform threshold of counts determined from the dog model to define perfusion defects. Interobserver variability as well as sensitivity and specificity of detecting coronary disease were examined. In patients with coronary artery disease interobserver variability was improved by using the computer technique: observers agreed as to the existence of a perfusion defect in 93% of the scintigrams as compared to 55% and 81% for the unprocessed and background-subtracted images respectively. No false positive indications of coronary disease were obtained by any of the three techniques. Use of the computer method did not improve the sensitivity of detecting coronary disease, however--71% compared to 64% for unprocessed images and 79% for background-substracted images. The advantages of this quantitative computer method are increased consistency of interpretation and lack of false positive diagnoses of coronary disease. An improved sensitivity of detection may be gained by varying thallium count thresholds according to anatomic location in the heart.

Platelet aggregation in feline cardiomyopathy.

Platelet aggregation in response to adenosine diphosphate (ADP) was evaluated in 16 healthy cats and in 10 cats with cardiomyopathy. The minimum threshold concentration of ADP required to induce irreversible (2nd-phase) aggregation was determined in each cat. The minimum ADP concentration needed for 2nd-phase aggregation in platelets from healthy cats ranged from 1 microM to 100 microM ADP, with 56% (9/16) requiring 100 microM ADP. Of the remaining seven normal cats, three had platelets responding irreversibly to 10 microM ADP, and four had platelets responding to 1 microM ADP. In cats with cardiomyopathy, the threshold concentrations ranged from 0.01 microM ADP to 10 microM ADP. Two cats had platelets responding irreversibly to 0.01 microM ADP, whereas another cat had a threshold response at 0.1 microM ADP. Platelets from the remaining seven cats with cardiomyopathy exhibited 2nd-phase aggregation in response to 1 microM ADP (five cats) or 10 microM ADP (two cats). Platelet counts ranged from 210,000/mm3 to 630,000/mm3 in healthy cats and from 218,000/mm3 to 624,000/mm3 in cats with cardiomyopathy. There was no apparent correlation between the platelet count and the magnitude of the threshold aggregation response, as measured by lag phase and slope of the aggregation curves. The results indicate that some cats with cardiomyopathy have platelets that are hyperaggregable to ADP in vitro.

Clinical, echocardiographic, and neurohormonal effects of a sodium-restricted diet in dogs with heart failure.

The use of low-sodium diets in dogs with heart failure is common practice, but randomized, double-blind studies have not been conducted to examine the benefits or problems with this approach. The purpose of this study was to determine the effects of a low-sodium diet on clinical, echocardiographic, and neurohormonal parameters in dogs with heart failure. Dogs with stable chronic heart failure were fed exclusively a low-sodium (LS) and a moderate-sodium (MS) diet for 4 weeks each in a randomized, double-blind, crossover design. At days 0, 28, and 56, echocardiography and thoracic radiography were performed, and blood was analyzed for electrolytes and neurohormones. Fourteen dogs completed the study (9 with chronic valvular disease and 5 with dilated cardiomyopathy). Electrolyte abnormalities were common during the study, and serum sodium and chloride concentrations decreased significantly on the LS diet. Neurohormones did not change significantly between diet groups. Maximum left atrial (P = .05) and standard left atrial (P = .09) size decreased on the LS diet. For dogs with chronic valvular disease, vertebral heart score (P = .05), left ventricular internal dimension in diastole (P = .006) and systole (P = .02), standard left atrial dimension (P = .03), maximum left atrial dimension (P = .02), end-diastolic volume index (P = .02), and end-systolic volume index (P = .04) decreased significantly on the LS diet compared to the MS diet. Although analysis of these data suggests some benefits of a low-sodium diet, future studies with improved study design are needed to further evaluate the advantages and disadvantages of sodium restriction in dogs with heart failure.

Nutritional alterations and the effect of fish oil supplementation in dogs with heart failure.

Alterations in body composition and nutritional status are common in humans with heart failure and are related, in part, to increases in cytokine concentrations. Cytokines have not been studied previously in dogs with naturally occurring cardiac disease nor has fish oil administration been used in this population to decrease cytokine production. The purposes of this study were to characterize nutritional and cytokine alterations in dogs with heart failure and to test the ability of fish oil to reduce cytokines and improve clinical outcome. Body composition, insulinlike growth factor-1, fatty acids, and cytokines were measured in 28 dogs with heart failure and in 5 healthy controls. Dogs with heart failure then were randomized to receive either fish oil or placebo for 8 weeks. All parameters were measured again at the end of the study period. At baseline, 54% of dogs with heart failure were cachectic and the severity of cachexia correlated with circulating tumor necrosis factor-alpha concentrations (P = .05). Cytokine concentrations at baseline, however, were not significantly increased in dogs with heart failure compared to controls. Baseline plasma arachidonic acid (P = .02), eicosapentaenoic acid (P = .03), and docosahexaenoic acid (P = .004) concentrations were lower in dogs with heart failure than in controls. Fish oil supplementation decreased interleukin-1 beta (IL-1) concentrations (P = .02) and improved cachexia (P = .01) compared to the placebo group. The mean caloric intake of the heart failure dogs as a group was below the maintenance energy requirement (P < .001), but no difference was found in food intake between the fish oil and placebo groups. Insulinlike growth factor-1 concentrations (P = .01) and reductions in circulating IL-1 concentrations over the study period (P = .02) correlated with survival. These data demonstrate that canine heart failure is associated with cachexia, alterations in fatty acids, and reduced caloric intake. Fish oil supplementation decreased IL-1 concentrations and improved cachexia. In addition, reductions in IL-1 predicted survival, suggesting that anticytokine strategies may benefit patients with heart failure.

M-mode echocardiographic values in sheep.

M-mode echocardiograms were recorded from 21 adult sheep (20 ewes, 1 whether). Fifteen echocardiographic measurements were taken and compared with body weights or heart rates, using linear regression equations. Significant correlations (P less than 0.05) were found when body weight was compared with left ventricular internal dimensions in systole (Yo = 0.187 Xo + 18.60, P less than 0.05) and diastole (Yo = 0.346 Xo + 26.69, P less than 0.02), septal thickness in systole (Yo = 0.0876 Xo + 7.64, P less than 0.05) and diastole (Yo = 0.0673 Xo + 4.45, P less than 0.05), aortic root dimension (Yo = 0.129 Xo + 23.40, P less than 0.05), and left atrial dimension (Yo = 0.194 Xo + 15.95, P less than 0.005). Heart rate was significantly correlated (P less than 0.05) with body weight (Yo = -0.245 X 96.71, P less than 0.05), ejection time (Yo = -0.0013 Xo + 0.376, P less than 0.001), velocity of circumferential fiber shortening (Yo = 0.0061 Xo + 0.928, P less than 0.05), mean velocity of mitral valve middiastolic closure (Yo = -0.184 Xo + 1.65, P less than 0.02), and left atrial dimension (Yo = -0.109 + 40.55, P less than 0.005). Fractional shortening of the left ventricle was (mean) 37.2 +/- 5.7% and the left atrial to aortic root ratio was (mean) 0.92 +/- 0.10.

Variance of indirect blood pressure measurements and prevalence of hypertension in clinically normal dogs.

In a series of 3 studies, indirect blood pressure measurements were obtained to define normal variance, identify hypertension, and estimate the prevalence of hypertension in apparently healthy dogs. In part 1, we measured values in 5 clinically normal dogs twice weekly for 5 weeks in a home setting. Mean +/- SD systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) was 150 +/- 16 and 86 +/- 13 mm of Hg, respectively. The DAP significantly (P less than 0.01) decreased with repeated measurements over the 5-week period. In part 2, we assessed the variation between blood pressures measured in a clinic vs those measured in the home. Within a 2-week period, measurements were obtained from 10 clinically normal dogs in a private veterinary clinic and again in their home. Significant differences were not observed between clinic and home measurements of SAP and DAP; however, heart rate was significantly (P less than 0.05) higher in the clinic. In part 3, SD about the SAP and DAP mean values were determined in 102 clinically normal dogs. Canine hypertensive status was determined, using statistical methods and data from 102 clinically normal dogs. Values of SAP greater than 202 mm of Hg and DAP greater than 116 mm of Hg were determined to be 2 SD beyond the mean and, therefore, were interpreted to be hypertensive. Approximately 10% of the 102 apparently healthy dogs measured in this study were considered hypertensive on the basis of these criteria. In addition, a border zone of suspected hypertension was estimated, using the mean + 1.282 SD. The SAP border zone was between 183 and 202 mm of Hg, whereas the DAP border zone was between 102 and 113 mm of Hg. Of the 102 dogs, 12 had values within these zones of suspected hypertension.