Hodgkin's and non-Hodgkin's lymphoma of the head and neck

OBJECTIVES/HYPOTHESIS

Lymphomas are a frequent cause of malignant lymphadenopathy in the head and neck. This study was performed to evaluate the head and neck manifestations of lymphomas and to emphasize the different presentations of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL).

STUDY DESIGN

Retrospective review.

METHODS

A retrospective review was made of all cases of lymphomas involving the head and neck at Marshfield Clinic (Marshfield, WI) between 1988 and 1996. Specifically, the clinical presentations, staging, and prognosis for HD and NHL with head and neck involvement were sought.

RESULTS

Three hundred eleven patients were included in the study, 76 with HD and 235 with NHL. The median age at diagnosis for patients with HD was 27.7 years, and for patients with NHL, 67.2 years. This difference was highly significant (P <.001). No significant difference in gender was noted, with male patients occurring in 59% with HD and 49% with NHL (P=.135). Extranodal involvement including the oral cavity, oropharynx, nasopharynx, paranasal sinuses, and larynx occurred with HD in 3 patients (4%) and with NHL in 54 patients (23% P <.001). Cervical adenopathy consisted of a single node in 24% of patients with HD and 33% of those with NHL (no significant difference, P=.236). The difference in mediastinal nodal involvement was highly significant, occurring in 65% of patients with HD and 38% of patients with NHL(P <.001). Abdominal nodes occurred in 20% of cases of HD and 45% of cases of NHL (P<.001). A significant difference in constitutional symptoms was noted with 41% of cases in HD and 27% of cases in NHL (P=.020). For the percentage of patients with stage IV disease, there was a highly significant difference by diagnosis with 10% in HD and 36% in NHL (P <.001). The median follow-up time was 51 months, and 12% of patients with HD and 41% of patients with NHL died of their disease. Both the overall survival and survival from death attributable to disease were significantly better for HD(P<.001).

CONCLUSIONS

Hodgkin's disease presents at a younger age and is less common than NHL. Cervical lymphadenopathy is the most common head and neck presentation for both diseases. Associated mediastinal adenopathy was more common with HD, and abdominal adenopathy with NHL. Constitutional symptoms were more common with HD. More advanced disease with a decreased overall survival was seen with NHL.

A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults

PURPOSE

We performed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of 0.12% zinc sulfate nasal spray for reducing the duration and severity of acute upper respiratory infections.

SUBJECTS AND METHODS

Patients with acute onset of upper respiratory illness of less than 24 hours' duration were eligible for the study. A nasopharyngeal swab was obtained at the time of enrollment for viral culture. Participants were randomly assigned to receive either 0.12% zinc sulfate or isotonic placebo spray. The medication was administered as two inhalations in each nostril four times a day. Each patient completed a diary card twice a day to record oral temperature, symptoms, and adverse effects. Symptoms were scored as absent (0), mild (1), moderate (2), or severe (3).

RESULTS

One hundred eighty-five subjects volunteered to participate, and 160 met the criteria for enrollment. The median duration of all symptoms was 7 days in both groups (P = 0.45), and the median duration of nasal symptoms was 6 days in both groups (P= 0.12). After adjustment for baseline differences in severity, patients receiving zinc had a significant reduction in the total symptom score (P= 0.02) and the nasal symptom score (P= 0.02) on day 1, but not on any of the other days. Adverse effects were mild and had no significant association with the use of zinc. A respiratory virus was identified in 9 of the 160 participants; 6 of these were rhinovirus.

CONCLUSION

A low concentration of zinc sulfate nasal spray had no effect on the duration of the common cold.

Duration of positive urine for cocaine metabolite after ophthalmic administration: implications for testing patients with suspected Horner syndrome using ophthalmic cocaine

PURPOSE

To determine the duration of positive urine for benzoylecgonine, the major metabolite excreted in the urine, after topical ophthalmic administration of cocaine as one would perform for testing the presence of Horner syndrome.

METHODS

Two drops of cocaine 10% were applied to each eye of 50 normal subjects. Urine samples were collected 4 to 6, 24, 48, 72, and 96 hours later. Each sample was assayed for benzoylecgonine using a screening competitive enzyme donor immunoassay followed by a highly specific and sensitive confirmatory gas chromatography-mass spectrometry assay. We employed assays and cutoff levels that fulfilled guidelines required by the Substance Abuse and Mental Health Services of the United States Department of Health and Human Services to mimic measures that exist for federal workplace drug testing.

RESULTS

Of the 50 subjects, there were 25 women and 25 men, ranging in age from 19 to 59 years (median age, 40 years). Positive screening samples were obtained in 47 of 50 subjects (94%) 4 to 6 hours, 35 of 50 (70%) 24 hours, and 1 of 50 (2%) 48 hours after topical application of cocaine. None of the samples tested positive at 72 hours or beyond. Using the confirmatory assay's cutoff as the gold standard for a positive test, the sensitivity of the screening assay was 96% 4 to 6 hours, 90% 24 hours, and 14% 48 hours after topical application. Urine benzoylecgonine concentration was negatively correlated with body mass index and positively correlated with urine creatinine concentration.

CONCLUSIONS

Patients should be informed that their urine may test positive for cocaine, if assayed according to US federal guidelines and using the protocol employed in this study, up to 2 days after undergoing testing for Horner syndrome.

Geriatric oral health issues in the United States

Of the more than 270 million people in the United States, about 13 per cent are aged 65 years or older. As in most other countries throughout the world, this proportion of the population is projected to increase in the coming years. To care for this ageing and racially/ethnically diverse population, health care professionals, especially dentists, must initiate changes in public policies, available resources and access to services. The dental profession especially must improve awareness among the general public and health care professionals of the link between oral health and general health. Immediate improvements should be made to increase the proportion of dentists who are willing and qualified to treat these patient groups. Increasing the reimbursement rates available through the Medicaid programme and expanding the types of services Medicaid recipients can seek are critical. Dental education programmes must continue to provide more training opportunities to prepare professionals to meet the needs of these patients.

Briefing of orthodontic patients

The aim of this study was to record the level of relevant knowledge among orthodontic patients and their parents in order to determine how they prepare for the first consultation and what level of orthodontic briefing is needed. The focus was on the response of young patients to briefing, with other objectives being to investigate what briefing media are used by orthodontists for patient motivation and improved compliance as well as the extent to which new briefing media are needed. Two hundred 9- to 12-year-old patients and their parents were interviewed, using a standardized questionnaire to record their knowledge and their need for information on orthodontic matters. In addition, 200 orthodontists were asked to fill in a questionnaire and to return it together with the briefing material used by them. The response rate was 62%.--To obtain an overview of the orthodontic briefing material available, various institutions (PR offices of health insurance companies, professional associations, specialist publishing houses, regional study groups) were approached with written requests for relevant material. Currently available children's books with dental or orthodontic subject matter were also scrutinized. 74% of children wanted to learn more about their orthodontic treatment and 40% expressed anxiety, in particular towards fixed appliances and impression-taking. 98% of orthodontists reported that the briefing interview was the main source of information. Despite being the person primarily in need of motivation, however, the child was not the focus of attention at the first consultation, even though that consultation was the preferred source of information for 51% of children. Other briefing media, consisting mainly of demonstration models and leaflets, were used primarily in the orthodontist's waiting room and surgery. Space-taking media (video films, computers) were rarely used, as were books. It is concluded that there is a clear-cut need for the orthodontic briefing process to be improved.

Histamine poisoning associated with eating tuna burgers

CONTEXT

Histamine poisoning occurs when persons ingest fish in which bacteria have converted histidine to histamine, a process that usually can be controlled by storage at low temperatures. From 1994 to 1997, North Carolina averaged 2 cases annually; however, from July 1998 to February 1999, a total of 22 cases of histamine fish poisoning were reported.

OBJECTIVES

To examine the increase in histamine case reports, identify risk factors for poisoning, and develop recommendations for prevention.

DESIGN AND SETTING

Case series evaluated in North Carolina from July 1998 to February 1999.

SUBJECTS

Reported case-patients with 2 of the following symptoms within 2 hours of eating tuna: rash, facial flushing, vomiting, diarrhea, dyspnea, a tight feeling in the throat, headache, or a metallic or peppery taste in the mouth.

RESULTS

Twenty cases occurred during 5 outbreaks, and there were 2 single occurrences. Of the 22 persons affected, 19 (86%) sought emergency medical care. All case-patients ate tuna: 18 ate tuna burgers, 2 ate salad containing tuna, and 2 ate filets. Tuna samples (available from 3 outbreaks) had histamine levels above the Food and Drug Administration regulatory level of 50 ppm (levels were between 213 and 3245 ppm). In 19 cases, the tuna used to prepare burgers or salads was frozen and thawed more than once before serving. Violations of recommended temperature controls were identified in 2 of the 5 restaurants, accounting for 14 (64%) cases.

CONCLUSIONS

Tuna burgers, a relatively new menu item in restaurants, were associated with an increase in histamine poisoning cases in North Carolina. Tuna ground for burgers can be susceptible to both temperature fluctuations and bacterial contamination.

[Capillaries of the myocardium of Lama (Lama glama)]

The heart of 12 adult llamas, one female and 11 males, 2-7 years of age, was studied gross-anatomically (absolute and relative heart weight) and microscopic-anatomically (left and right ventricular wall, left auricle). Comparing the 9 younger animals (2-3 years old) with the 3 older llamas (5-7 years old) a significant increase of the absolute heart weight and of the number of capillaries per mm2 and a significant decrease of the intercapillary distance in the left ventricular wall was found. This results in an increase of capillarity in the studied heart regions (5.5% compared to 6.9%). The simultaneous increase of the capillary-to-myocyte-ratios from 0.9 to 1.1 shows a significant correlation to the cross-sectional area of the myocytes (r = 0.79) and an also significant but negative correlation to the number of myocytes per mm2 (r = -0.82). In both groups the cross-sectional area of the myocytes and their diameter differs significantly in the three regions of the heart (left ventricular wall--214 micron 2 resp. 17.5 microns; right ventricular wall--156 micron 2 resp. 15.5 microns; left auricle--96 micron 2 resp. 11.5 microns). It is to be supposed, that the morphological conditions of the cardiac vascular supply of llamas living in an altitude of 4000 m are improving with age.

Cardiac risk stratification of patients with symptomatic spinal stenosis

The leading cause of death in the perioperative period after noncardiac surgery is a cardiac event. As the number of lumbar surgeries performed in patients older than 65 years of age continues to increase, this patient population with neurogenic claudications is an at risk group for a cardiac event because of their age and associated cardiac risk factors. The authors attempted to document by means of cardiac chemical stress testing, the prevalence of silent ischemic cardiac disease in patients with neurogenic claudication who were candidates for elective lumbar surgery. Eleven of 140 patients (8%) had induced cardiac wall abnormalities on stress testing, indicating myocardial ischemia. The only risk factors associated with cardiac ischemia were smoking and history of heart disease. It is recommended that dobutamine stress echocardiography be performed in patients undergoing elective spinal surgery for symptomatic spinal stenosis if they have a history of previous heart disease, smoking, or both.

Placebo-controlled evaluation of amphetamine mixture-dextroamphetamine salts and amphetamine salts (Adderall): efficacy rate and side effects

OBJECTIVE

The primary objective of this study was to determine the efficacy rate of Adderall in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). A secondary objective was to address the severity of side effects associated with Adderall treatment in children with ADHD using the Barkley Side Effects Questionnaire (BSEQ).

DESIGN

Randomized, double-blind, placebo-controlled crossover trial.

SETTING

A large rural tertiary care clinic.

PATIENTS

Participants were prospectively recruited from children 5 to 18 years of age referred for academic and/or attention problems; 154 children who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for ADHD were enrolled. Interventions. Two doses of Adderall (0.15 mg/kg/dose and 0.3 mg/kg/dose) were compared with placebo in separate 2-week trials. Participants received each dosage regimen twice daily for 7 consecutive days.

MEASUREMENTS AND MAIN RESULTS

Efficacy rates were determined by comparing Adderall with placebo during the low-dose crossover sequence and also during the high-dose crossover sequence. The criteria that defined a positive response to Adderall relative to placebo (with each patient serving as their own control) included an indication of response by at least 1 of 2 parent measures of children's behavior or at least 2 of 5 teacher measures of children's behavior. The Adderall efficacy rate was determined based on parent criteria alone, teacher criteria alone, and by a more stringent definition of response that required concurrence between parent and teacher criteria. The Adderall response rate in this study ranged from 59% when requiring concurrence between parent and teacher observers, to 82% when based on parent criteria alone. Overall, 137 of 154 participants (89%) showed a positive response by either the parent or teacher response criteria. Parents completed a modified version of the BSEQ during each week of the trial. Appetite, stomachaches, and insomnia were rated as worse by parents while children were receiving either dose of Adderall; headaches were rated as worse when children were receiving the higher dose of Adderall. Parents rated certain side effects, including staring/daydreaming, sadness, euphoria, and anxious/irritable, as worse during placebo regimens.

CONCLUSIONS

We found that Adderall is highly efficacious in our population of youth diagnosed with ADHD. In addition, Adderall is well-tolerated with a side effect profile similar to that reported for other psychostimulants.

Atopic dermatitis in 5-6-year-old Swedish children: cumulative incidence, point prevalence, and severity scoring

BACKGROUND

This study aimed to evaluate the cumulative incidence, point prevalence, and severity of atopic dermatitis (AD) in a pediatric population. We also aimed to identify differential diagnoses relevant to AD in this population.

METHODS

Children scheduled for a health visit at 5.5 years of age were selected consecutively during the period October 1997-March 1998 from two cities in southern Sweden (Göteborg and Kristianstad). Schultz Larsen's questionnaire was used to evaluate the cumulative incidence of AD. Clinical examination was performed by dermatologists (A.B. and A.S.) for those children with active eczema. The UK working party's criteria were used for the clinical diagnosis of AD. The SCORAD index was used to evaluate the severity of eczema. This index includes evaluation of extent, intensity, and subjective symptoms to a maximum score of 103 points.

RESULTS

In Göteborg 1219 and in Kristianstad 742 questionnaires were answered regarding 1961 children, 1004 boys and 957 girls. The response rate was 89%. According to the answers to Schultz Larsen's questionnaire, the cumulative incidence of AD in the whole material was 20.7% (406/1961) (CI 95% 18.9-22.5). In Göteborg, 104 of the examined children fulfilled the UK working party's criteria, equivalent to a point prevalence of 8.5% (CI 95% 7.0-10.1). In Kristianstad, the corresponding point prevalence was 11.5% (CI 95% 9.2-13.8). The severity of AD was evaluated in all children with visible eczema. SCORAD evaluation was performed in 155 of the 157 children with visible eczema. The majority of children had mild or moderate eczema; mean value 20.5 (CI 95% 18.7-22.3), median 19.6. Of the 96 children who did not fulfil the criteria of AD, other skin disorders were diagnosed in 51 at the clinical examination. Dry skin was by far the most common differential diagnosis.

CONCLUSIONS

We have used validated protocols to evaluate the cumulative incidence, point prevalence, and severity of AD in a population-based study in southern Sweden The present study, involving a rural and urban pediatric population, shows that AD is common, usually classified as mild or moderate, and seems to increase over time.

All-artery multigraft coronary artery bypass grafting with only internal thoracic arteries possible and safe: a randomized trial

BACKGROUND

The internal thoracic artery (ITA) bypass to the left anterior descending coronary artery is of proven benefit in multigraft coronary artery bypass. Total ITA grafts, if reoperation is averted by avoiding saphenous vein grafts (SVGs), are attractive. The safety of the total ITA graft operation (all-ITA) is a concern.

METHODS

A randomized trial of multiple-ITA bypass graftings with the use of bilateral sequential ITA without SVGs was performed. Control patients received 1 ITA plus SVG. Inclusion criteria were those used in the Coronary Artery Surgery Study, extended to age 76 years, and any angina class, except emergent. One hundred sixty-two patients were randomized (81 patients per group) from January 1, 1990, to December 31, 1994.

RESULTS

Baseline traits were similar as were cross-clamp times, pump times, and number of arteries bypassed (average, 4.3 arteries). Patients who received multiple ITA grafts had no myocardial infarctions, per reference laboratory. One patient died, and 2 patients returned for bleeding. The ITA-SVG group had similar results. The all-ITA group experienced successful completion in 93% of cases. Complications did not differ from control patients.

CONCLUSIONS

Early and 5-year outcomes were not different between the all-ITA group and the ITA with SVGs group. We believe experienced surgeons can safely extend the ITA to multibypass coronary artery bypass without use of SVG to achieve an all-ITA operation.

Spectrum of care treatment planning: application of the model in older adults

A model for treatment planning is presented to help emphasize the most important elements of the clinical decision-making process for older adult patients. The patient's concerns and needs in the domains of function, symptoms, pathology, and esthetics are the central elements of the process. With sophisticated assessment methods and creative interventions, the dentist can work with each patient to identify and successfully address his or her needs and concerns. This model is applied to two clinical cases which illustrate the importance of considering innovative treatment plans, even when the patient is advanced in years.

International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: * Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. * Preventing heat loss: Hyperthermia should be avoided. * Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO(2) detection can be useful in the secondary confirmation of endotracheal intubation. * Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. * Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. * Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

Impact of older adults on private dental practices, 1988-1998

BACKGROUND

A 1988 study indicated that older adults made up a substantial portion of regular patients seen in private dental practices. A follow-up study was conducted in 1998 to track changes over the decade in the participating practices.

METHODS

The authors collected data from respondents to the 1988 survey again in 1998. The authors received complete data from 41.7 percent of the original respondents who still were practicing at their 1988 addresses. Dentists kept a log of all procedures provided in their practices in one day. The authors attributed values of services in both years, using a 1997 national estimate of fees.

RESULTS

The authors found that the percentage of office visits, services provided and patient expenditures attributed to patients 65 years of age or older exceeded the percentage of the population in that age group. In four of the five age groups in which patients had the highest mean expenditures, patients were 60 years of age or older. Patients 60 years of age or older accounted for 28.8 percent of all patient expenditures, a 12.1 percent increase from 1988. Longitudinal analyses indicated that between 1988 and 1998, dentists 40 years of age or older experienced increases of 30.3 to 64.3 percent in the proportion of visits, services and expenditures by patients 65 years of age or older.

CONCLUSIONS

The results of this investigation illustrate the importance of older adults to dental practices. Data from the practices of dentists who participated in both surveys show increases in the percentage of total dental visits, total services provided and total patient expenditures attributed to older adults.

CLINICAL IMPLICATIONS

Older adults continue to have a disproportionate and positive impact on the surveyed dental practices and their financial well-being. Dentists should reevaluate the accessibility of their practices to this population. Rather than waiting for the practice to "age," dentists may want to structure their practices in ways that appeal directly to older adults and work to even better understand the needs and preferences of older patients already in their practices.

Serial extraction or premolar extraction in the permanent dentition? Comparison of duration and outcome of orthodontic treatment

Treatment outcome and duration of 2 different treatment approaches in 2 groups of comparable extraction cases were analyzed: Group I: serial extraction performed in the early mixed dentition followed by orthodontic treatment in the permanent dentition; group II: extractions as well as orthodontic treatment in the permanent dentition. The following conclusions were reached: 1. The treatment period with fixed appliances was highly significantly shorter in group I; however, the number of appointments was significantly higher and the total duration of treatment/observation time significantly longer. 2. In both groups the reduction in PAR score was either improved or greatly improved in all cases.

Laser-induced fluorescence studies of normal and malignant tumour tissue of rat following intravenous injection of delta-amino levulinic acid

BACKGROUND AND OBJECTIVE

Laser-induced fluorescence was studied in normal and tumour tissue of rat after intravenous injection of delta-amino levulinic acid (ALA). The aim of the study was to investigate the protoporphyrin IX accumulation in different tissue types in rat after systemically administered ALA.

STUDY DESIGN/MATERIAL AND METHODS

A malignant rat tumour and normal tissue from 13 different organs were investigated in eight rats. The rats were injected with two different ALA doses, 30 and 90 mg/kg b.w., and the investigations were performed at 10, 30 and 240 min after the injection. The fluorescence was recorded utilising an optical fibre based fluorosensor at 405 nm excitation.

RESULTS

Fluorescence spectra were recorded in the 400-750 nm wavelength region including the dual-peaked PpIX fluorescence at about 635 and 705 nm, and the tissue autofluorescence peaking at about 500 nm. The maximum tumour build-up of PpIX was achieved already in less than 1 hr after ALA injection. The fluorescence demarcation between tumour and surrounding tissue was a factor of 7-8:1 after 30 min and decreased for longer retention times. The accumulation in 13 different organs was investigated and a particularly high PpIX build-up was found in stomach and intestine.

CONCLUSIONS

Fluorescence detection following i.v. injection of ALA provides attractive diagnostics for the experimental tumour used, indicating clinical usefulness.

The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients. A randomized prospective study. Part II: Bacteriological parameters

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influences of a 0.2% chlorhexidine mouthrinse (Corsodyl, CHX) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to the bacteriological parameters. The bacteriological parameters of vital fluorescence, bacteriological counts (BC), colony forming units (CFU), plating efficiency (PE) and mutans streptococci (MS) were related to the clinically assessed indices of plaque and gingivitis. All parameters analyzed demonstrated significant differences between the control and the test (chlorhexidine) group. Where-as the values of BC, CFU, and PE progressively increased in the control group from T0 to T2, these parameters distinctly decreased in the chlorhexidine group. All values of vital flora (VF) scored around 75% in the control group compared to values of 30% in the test group. BC, CFU und PE correlated significantly. The score of mutans streptococci persisted or increased in the controls whereas mutans streptococci approached 0 in the chlorhexidine group. Until the 5th day of washout a clear-cut carry over of the chlorhexidine rinse on mutans streptococci as well as on the gingival index was evident. Since dead microorganisms remain on the tooth surface and in order to maintain oral health, chlorhexidine application might advisedly be supplemented by mechanical plaque control.

The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients. A randomized prospective study. Part I: clinical parameters

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influence of a 0.2% chlorhexidine (CHX) mouthrinse (Corsodyl) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to plaque and gingivitis. Before starting the first test phase there was a 14-day preliminary phase for upgrading the oral hygiene. Between the 2 test phases was a 5-day "washout". On the last day of the second test phase the patients were asked to fill in a questionnaire concerning their experiences during the study. The 0.2% Corsodyl reduced the plaque index scores significantly (p < 0.001). The gingival index revealed a similar reduction (2nd day of test: p = 0.03). Until the 5th day of washout a clear-cut carryover effect of the chlorhexidine rinse on the gingival index was observed. Both the lower mean values of the 2 clinical parameters at the beginning of the test phases as compared with those at the beginning of the preliminary phase and the evaluation of the questionnaires indicated a possible Hawthorne effect. 0.2% Corsodyl may be employed as an adjunct to other preventive measures such as professional care and patient-oriented instruction on an intermittent basis in order to reduce the plaque-induced iatrogenic side effects and to enhance the efficacy of oral hygiene measures in connection with orthodontic therapy with fixed appliances.

Evaluation of labio-lingual bony support of lower incisors in orthodontically untreated adults with the help of computed tomography

The aim of the present study was to assess bone volume and bone density in orthodontically untreated adults using a CT analyzing method, with reference data in the clinically essential area of the lower incisors being obtained. For quantitative and qualitative assessment of the labial and lingual bony support of the lower incisors, existing CT-images of 20 adult men with a near-to-normal occlusion and a clinically healthy periodontal situation were evaluated. With the help of a special program (SIM/Plant) and on the basis of axial scans, sagittal scans were constructed, permitting the individual imaging of the lower incisors and their alveolar process. The bony support of each tooth was registered labially and lingually perpendicular to the tooth axis at intervals corresponding to 10% of the root length. At the various root levels, especially at the upper parts of the roots, only small amounts of bony support, if any, were frequently observed. Labially, bony fenestrations and dehiscences were frequently seen, but lingually mostly dehiscences. No clinically relevant association was found between labial bony support and cephalometrically registered inclination of the lower incisors. Bone density, which was registered in Hounsfield units at the gingival, middle and apical thirds of the root levels, increased from the gingival to the apical thirds of the roots, generally with lower lingual than labial values. Before initiating orthodontic treatment a thorough clinical assessment of the anatomical situation in the lower incisor segment should be carried out. At present bone volume in this area can be reliably assessed only with computed tomography; however, this has to be weighed up against increased radiation risks. Therefore, the form of the symphysis should initially be roughly assessed by means of conventional cephalometry, with additional CT-based analysis of individual teeth being confined to special indications.

Adult patients' view of orthodontic treatment outcome compared to professional assessments

One important aspect in evaluating the outcome and quality of orthodontic treatment is the patient's own assessment. The objective of this study was to evaluate the course and outcome of orthodontic treatment in adults from the patient's vs the operator's point of view. In a previous study, the orthodontic treatment of 88 adults was evaluated using the IOTN and PAR Index before and after treatment. Fifty-nine patients answered treatment questionnaires on 1. the reason for seeking treatment, 2. dentofacial aesthetics, 3. treatment outcome, 4. course of treatment, 5. attitude, 6. social well-being. Depending on the original treatment goal, the patient population was divided into an Ideal Group and a Compromise Group. In 75% of the patients, dissatisfaction with dental aesthetics was the prime motive for seeking treatment; correlations with PAR parameters (overjet and maxillary anterior teeth) were weak. In general, a high degree of patient satisfaction with orthodontic treatment was registered. As regards satisfaction with post-treatment dental aesthetics there were no significant differences between the groups. Comparison of professional assessment with the subjective rating by patients revealed discrepancies in that the patients' rating of outcome tended to be more positive. The differentiation between ideal and compromise treatment goals proved useful. In the Compromise Group, a high level of patient satisfaction was attained with a shorter treatment duration and lower appliance involvement. 92% considered their major pre-treatment need to have been met, and 95% would have had the treatment performed again.