Cracked and broken teeth--definitions, differential diagnosis and treatment

Cracked and broken teeth present a diagnostic dilemma to the dentist and the sooner a correct diagnosis is made the greater are the chances to save the tooth. As the location, direction and size of the crack or fracture dictates the choice of treatment, it is important to first define the types of cracks and fractures in the coronal and radicular tooth structure. Cracks and fractures can be classified as follows: 1. craze lines 2. fractured cusps 3. cracked teeth 4. split teeth 5. vertical root fractures. The vertical root fracture has been described recently in two articles in this publication, and therefore will not be discussed here. Diagnosis of a cracked tooth is not always initially obvious. The patient's response to clinical testing is the primary diagnostic tool along with the dental history provided by the patient. Radiographs are secondary in making a diagnosis. Clinical aids for reproducing the patient's symptoms such as occlusal bite devices, observing occlusal wear facets and the application of cold water to one tooth at a time may isolate the offending tooth. In situations where an irreversible pulpitis is diagnosed, endodontic treatment is indicated. In the case of a questionable diagnosis, or one in which a potential reversible pulpitis is made, a provisional restoration can be placed for an unspecified time as a diagnostic aid. If endodontic therapy were indicated, consultation with the patient as to the compromised prognosis and the alternatives to endodontic treatment is essential.

Intercultural communication competence in family medicine: lessons from the field

OBJECTIVE

To describe the challenges for immigrant patients and their physicians and their skills in intercultural communication (ICC).

METHODS

We videotaped one clinical encounter for each of 24 psychologically distressed patients visiting their regular family physician. The physician and the patient, each separately, viewed the videotape of their clinical encounter and commented on important moments identified by the participant or the researchers.

RESULTS

Patients and/or physicians lacked knowledge of the effects of culture on the doctor-patient relationship and expressions of distress as well as the effects of immigrant-specific stress on health. Most subjects were motivated to have an interpersonal, rather than an intercultural encounter. Physicians and patients demonstrated the skills needed to achieve an interpersonal encounter. Some physicians and their patients achieved intercultural meetings as a result of their interpersonal interactions over a period of years.

DISCUSSION

Lack of formal training partly explains why most participants demonstrated an elementary level of ICC. In addition, Identity Management Theory and Co-cultural Theory explain some of the barriers to ICC.

PRACTICE IMPLICATIONS

Providing physicians with formal training in intercultural communication and empowerment training for patients is likely to improve the quality of care of immigrants.

Thalassomonas loyana sp. nov., a causative agent of the white plague-like disease of corals on the Eilat coral reef

The taxonomic position of the coral pathogen strain CBMAI 722T was determined on the basis of molecular and phenotypic data. We clearly show that the novel isolate CBMAI 722 T is a member of the family Colwelliaceae, with Thalassomonas ganghwensis as the nearest neighbour (95 % 16S rRNA gene sequence similarity). CBMAI 722T can be differentiated from its nearest neighbour on the basis of phenotypic and chemotaxonomic features, including the utilization of cellobiose and L-arginine, the production of alginase and amylase, but not oxidase, and the presence of the fatty acids 12:0 3-OH and 14:0, but not 10:0 or 15:0. The DNA G+C content of CBMAI 722T is 39.3 mol%. We conclude that this strain represents a novel species for which we propose the name Thalassomonas loyana sp. nov., with the type strain CBMAI 722T (=LMG 22536T). This is the first report of the involvement of a member of the family Colwelliaceae in coral white plague-like disease.

Laboratory markers associated with progression of HIV infection

Infection with HIV may develop to AIDS at different rates in different individuals, with a spectrum varying from rapid progression to long-term non-progression. The variable course of HIV-1 infection causes emotional trauma for the infected person and complicates the design and interpretation of therapeutic trials because of unrecognized differences in prognosis. Owing to the variable clinical expression of HIV infection, the use of non-clinical disease markers has become important to patient management. Thus, it is essential to have tests which can accurately assess the stage of infection in an individual, as well as predict its course and monitor its progression. These laboratory tests are valuable during the period of clinical latency and subsequently supplement various clinical parameters.

The AlnB protein of the bioemulsan alasan is a peroxiredoxin

The bioemulsifier of Acinetobacter radioresistens KA53, referred to as alasan, is a high molecular weight complex of a polysaccharide and three proteins (AlnA, AlnB and AlnC). AlnA has previously been shown to be an OmpA-like protein that is largely responsible for the emulsifying activity of alasan. To further elucidate the nature of alasan, the gene coding for AlnB was cloned, sequenced and overexpressed in Escherichia coli. The overall 561 bp sequence of the hypothetical AlnB showed strong homology, including all conserved regions and residues known to be essential for enzymatic activity, to the ubiquitous family of thiol-specific antioxidant enzymes known as peroxiredoxins. Transgenic E. coli overexpressing AlnB exhibited increased resistance to cumene hydroperoxide both in liquid culture and on agar medium. Recombinant AlnB had no emulsifying activity but stabilized oil-in-water emulsion generated by AlnA.

Comparison of different chloroformates for the derivatisation of seleno amino acids for gas chromatographic analysis

Three chloroformate reagents, ethyl chloroformate (ECF), methyl chloroformate (MCF) and menthyl chloroformate (MenCF), have been used for the derivatisation of seleno amino acids and their performance was compared. Chromatographic parameters and the inertness of the different instrumental configurations used (gas chromatography-atomic emission detection (GC-AED), and GC-MS) were shown to have a significant influence on the detection of various seleno amino acids (selenomethione, selenoethione and selenocysteine) and some sulphur-containing amino acids (methionine, cysteine, cystine and methylcysteine) which were included in the experiments for comparison. Methyl chloroformate was the preferred derivatisation reagent, since it generally performed best in terms of derivatisation yield and reproducibility and also showed less significant conditioning effects than ethyl chloroformate. Methyl and ethyl chloroformate derivatives of selenomethionine, selenoethionine, cysteine and methionine were detectable, while the detection of the menthyl chloroformate derivatives of selenocystine and cystine was not reproducible. Overall efficiencies for the determination of selenomethionine and selenoethionine from aqueous extracts ranged from 40 to 100% for methyl chloroformate, over 30-75% for ethyl chloroformate to 15-70% for menthyl chloroformate for different series measured over a period of months. The relative standard deviation of the method for the methyl and menthyl chloroformate derivatisation ranged from 7 to 13% without internal standard and was improved to 2% for the determination of selenomethionine using selenoethionine as internal standard. This indicates that, despite the limited reproducibility of the method, its repeatability is good enough to allow accurate determination of seleno amino acids, which was also demonstrated by the analysis of selenium supplementation tablets for human diet that contained selenomethionine.

Endodontic treatment of developmental anomalies in posterior teeth: treatment of geminated/fused teeth--report of two cases

AIM

Gemination or fusion is a rare occurrence in the mandibular posterior teeth. Endodontic treatment of these teeth needs special care and attention to the bizarre anatomy. The aim of this article is to describe the problems encountered and the strategy in treating such cases.

CASE REPORT

Two cases of complex endodontic treatment of fused/geminated teeth are presented. The first is an 11-year-old girl with an anomalous 'double' first mandibular molar and premolar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin; the second is a 16-year-old boy with 'double' second and supernumerary mandibular molars, who was diagnosed with irreversible pulpitis. Both cases were treated successfully in multiple appointments. The common features and treatment modalities are discussed.

KEY LEARNING POINTS

Failure to diagnose fused/geminated teeth leads to misdiagnosis and a treatment plan that could cause permanent damage and tooth loss. Generally, there is communication between root canal systems of fused/geminated teeth which should be treated as one entity. Use of magnification is an important aid during treatment.

Comparison of procedural errors resulting during root canal preparations completed by junior dental students in patients using an '8-step method' versus 'serial step-back technique.'

AIM

To compare procedural errors occurring during preparation of root canals by junior dental students in patients using a new '8-step method' versus traditional 'serial step-back technique.

METHODOLOGY

Junior dental students treated 291 root canals of maxillary and mandibular teeth in patients. A new '8-step method' was used to prepare 149 canals, whilst the traditional 'serial step-back technique' was used for 142 root canals. Instrumentation was carried out in both techniques using standardized stainless steel K-files and coronal flaring with Gates-Glidden reamers. In the apical one-third, a filing motion was used in the traditional technique: with the '8-step method,' reaming or filing motions were used in sizes up to 25 and only reaming in sizes larger than 25. All root canals were obturated with gutta-percha points and AH26 using a lateral condensation technique. Pre- and postoperative radiographs were made of each tooth. Procedural errors were recorded and statistically analysed using a binomic test for comparison of proportion.

RESULTS

Significantly (P < (1.0001) more root canals maintained their original shape with no deviation (91%) with the'8-step method' compared to the traditional 'serial step-back technique' (61%). The procedural errors detected with the'8-step method' consisted of 10 canals with transportation (5%) and five with root perforations (2%); there were no canal obstructions. With the 'serial step-back technique: significantly (P < 0.0001) more errors occurred: 28 canals were transported (17%), 10 had root perforations (7%), and 16 canals were obstructed (6%). The differences in maintaining the original root canal shape between the two methods were significantly greater in molar versus anterior teeth.

CONCLUSIONS

The new '8-step method' resulted in fewer procedural errors than the traditional 'serial step-back technique' when junior students prepared root canals in patients.

Vibrio coralliilyticus sp. nov., a temperature-dependent pathogen of the coral Pocillopora damicornis

Vibrio sp. YB1T (=ATCC BAA-450T =LMG 20984T), the aetiological agent of tissue lysis of the coral Pocillopora damicornis, was characterized as a novel Vibrio species on the basis of 16S rDNA sequence, DNA-DNA hybridization data (G + C content is 45.6 mol%), AFLP and GTG5-PCR genomic fingerprinting patterns and phenotypic properties, including the cellular fatty acid profile. The predominant fatty acids were 16:0 and 18:1 omega7c. The name Vibrio coralliilyticus sp. nov. is proposed for the novel coral-pathogenic species. In addition to strain YB1T, which was isolated from the Indian Ocean, five additional strains of V. coralliilyticus have been isolated, three from diseased P. damicornis in the Red Sea, one from diseased oyster larvae (Kent, UK) and one from bivalve larvae (Brazil). The six V. coralliilyticus strains showed high genotypic and phenotypic similarities and all were pathogenic to P. damicornis. The closest phylogenetic neighbours to V. coralliilyticus are Vibrio tubiashii, Vibrio nereis and Vibrio shilonii.

Determinants of the diagnosis of psychological problems by primary care physicians in patients with normal GHQ-28 scores

In studies comparing the performance of psychometric instruments and general practitioners in the identification of psychological disorders, authors usually treat the psychometric instrument as the gold standard. Some patients may have no psychiatric diagnosis and normal scores on self-report measures of distress, but still benefit from detection and treatment of their psychosocial problems. However, physicians may be spending valuable time identifying problems in patients who have no disability. The extent and implications of the discrepancy between clinician assessment and standard instruments requires further exploration. Adult patients of 40 family physicians completed the General Health Questionnaire (GHQ-28) before their visit. Immediately following the visit, physicians, who were blind to the patient's GHQ score, indicated whether they had detected any signs or symptoms of anxiety, depression, somatization, or other psychosocial problems. Of the 1,011 primary care patients that participated, 439 had normal GHQ-28 scores. Physicians detected psychological problems in 177 (38.3%) of the 439. In bivariate analyses, poorer general and mental health (as measured by SF-36) was associated with higher detection rates. The patient's belief that there was a psychological component of his or her problem (OR=2.50), being in a marital relationship (OR=1.87), and the physician's perception of the seriousness of the problem (OR=1.84) were associated with detection. Detection was less frequent when the physician did not know the patient well (OR=0.69), and when the physician was a woman (OR=0.46). For the 28% of patients who themselves perceived a psychological element of their problem, physician detection was probably appropriate. However, it is unlikely that detection of the remaining patients was beneficial to the patients.

Solubilization of polyaromatic hydrocarbons by recombinant bioemulsifier AlnA

AlnA is the protein responsible for the emulsifying and solubilizing activity of the Acinetobacter radioresistens KA53 bioemulsifier alasan. AlnA was produced in Escherichia coli, purified to homogeneity and then used to measure the enhanced solubility of 12 polyaromatic hydrocarbons (PAHs). The amount of PAH solubilized was directly proportional to AlnA concentration. The ratio of PAH solubilized by 40 micro g/ml AlnA compared to that soluble in the aqueous buffer varied greatly, from 4 (fluorene) to 81 (hexylbenzylcyclosilane). Calculations of moles PAH solubilized per mole AlnA yielded values from 4.3 (hexylphenylbenzene) to 55.8 (1,10-phenanthrolene). There was no obvious relationship between the amount of PAH solubilized and its molecular weight or intrinsic solubility. Native gel electrophoresis indicated that AlnA formed hexamers in the presence of PAHs. With molar ratios of fluorene to AlnA of 0.75 or less, only the monomer was observed, whereas at ratios of 7.5 or higher, only the hexamer was detected. At an intermediate molar ratio of 2.6, both monomer and hexamer appeared. The data indicate that PAHs are initially solubilized by binding to the monomeric form of AlnA, and as the amount bound increases above one molecule PAH per AlnA, the protein aggregates to form a specific oligomer of 5-8 monomers which allows for the binding and solubilization of more PAH.

Universal screening method for the determination of US Environmental Protection Agency phenols at the lower ng l(-1) level in water samples by on-line solid-phase extraction-high-performance liquid chromatography-atmospheric pressure chemical ionization mass spectrometry within a single run

The applicability of a previously optimized method for the analysis of the US Environmental Protection Agency (EPA) regulations phenols, based on on-line solid-phase extraction coupled to liquid chromatography with mass spectrometric (MS) detection in different matrix loaded water samples is demonstrated. The comprehensive optimization of the mobile phase conditions and their influence on the ionization process in atmospheric pressure ionization is described in detail. In particular, MS detection of the weakly acidic phenols such as phenol, monochlorinated phenols and methylated phenols requires the absence of acidic mobile phase modifiers and buffers. Thus lower retention times and slight peak broadening of the more acidic dinitrophenols are obtained if the entire range of EPA phenols is analyzed within a single chromatographic run. The figures of merit for the method were determined and the applicability to real water samples was investigated. Limits of detection for phenols ranging from 40 to 280 ng l(-1) and relative standard deviations below 8% in SCAN mode are obtained for all phenols if only 10-ml river water samples with low dissolved organic carbon (DOC 5 mg C l(-1) concentrations are preconcentrated. The method was used to detect 2-nitrophenol and 4-nitrophenol in river water samples in the lower ng l(-1) range. The analysis of highly matrix-loaded samples (DOC 210 mg C l(-1)) requires a reduced enrichment volume resulting in decreased sensitivity. Still the method is capable of reaching excellent detection limits which demonstrates its excellent suitability for screening analysis.

Bone grafts and growth and differentiation factors for regenerative therapy: a review

Guided bone regeneration, tissue grafts, regenerative barrier membranes, and bone substitute materials have been used to restore inadequate hard and soft tissue structures to make them conducive to proper implant placement. Polypeptide growth and development factors (GDFs) have successfully been applied exogenously to periodontal defects to attract preosteoblasts to the site and accelerate their proliferation to stimulate angiogenesis. This article provides an overview of current modalities for restoring lost bone and soft tissue during the treatment of periodontal disease.

Development and evaluation of a calibration gas generator for the analysis of volatile organic compounds in air based on the injection method

The development and operational evaluation of a calibration gas generator for the analysis of volatile or ganic compounds (VOC) in air is described. Details of the construction, as well as of the evaluation of the apparatus are presented here. The performance of the test gas generator is validated both by on-line GC analysis of the calibration gas produced and by off-line analysis of adsorptive samples taken from the generated calibration gas. Both, active and passive sampling have been used, and the results demonstrate the excellent accuracy and precision of the generated test gas atmosphere: For the 11 investigated organic compounds (aromatic and halogenated compounds), the found values were in most cases within 5% of the target value with a reproducibility of better than 3% RSD (as determined by the analysis of the sampled adsorbent tubes). Custom made adsorbent tubes were used for active and passive sampling and in both cases were analysed by thermal-desorption GC. Particularly the combination of passive sampling and thermodesorption-GC analysis offers significant advantages over the commonly used active sampling on activated charcoal, followed by CS2 desorption in terms of avoidance of hazardous solvents, potential for automation and improved detection limits. Both sampling techniques are capable for monitoring VOCs at concentrations and under conditions relevant for workplace monitoring.

An unusual beta-ketoacyl:acyl carrier protein synthase and acyltransferase motifs in TaK, a putative protein required for biosynthesis of the antibiotic TA in Myxococcus xanthus

The antibiotic TA of Myxococcus xanthus is produced by a type-I polyketide synthase mechanism. Previous studies have indicated that TA genes are clustered within a 36-kb region. The chemical structure of TA indicates the need for several post-modification steps, which are introduced to form the final bioactive molecule. These include three C-methylations, an O-methylation and a specific hydroxylation. In this study, we describe the genetic analysis of taK, encoding a specific polyketide beta-ketoacyl:acyl carrier protein synthase, which contains an unusual beta-ketoacyl synthase and acyltransferase motifs and is likely to be involved in antibiotic TA post-modification. Functional analysis of this beta-ketoacyl:acyl carrier protein synthase by specific gene disruption suggests that it is essential for the production of an active TA molecule.

Expression of cell cycle regulators p57(KIP2), cyclin D1, and cyclin E in epithelial ovarian tumors and survival

The search for new prognostic indicators is especially important in the diagnosis and treatment of ovarian cancer because clinicopathologic criteria currently used to predict survival are largely inadequate. We examined 2 groups of patients with epithelial ovarian cancer, 1 group of long-term survivors (>5 years), and 1 group of short-term survivors (<2 years) for levels of expression of the cell cycle regulators p57(KIP2), cyclin D1, and cyclin E and their relationship with survival. Our findings show that p57(KIP2) is not associated with prognosis, in contrast to p27(KIP1) expression, which is previously shown to be positively associated with long-term survival in univariate analysis (P =.001). Cyclin E expression, in contrast to cyclin D1 expression, is marginally associated with short-term survival in univariate analysis for a group of 53 women. Among the short-term survivors, 15 (65%) of 23 were positive for cyclin E expression, compared with only 11 (37%) of 30 long-term survivors (P = 0.054). This association remained significant (P =.04) in a logistic regression analysis adjusted simultaneously for performance status and extent of residual disease, the 2 strongest predictors of survival in our study. We also found a significant difference in the frequency of the cyclin E staining pattern between nonserous and serous ovarian tumor subtypes (P =.0002). Immunostaining for levels of cyclin E and p27(KIP1) expression may have potential as prognostic markers in the management of ovarian cancer.