Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: US Preventive Services Task Force Recommendation Statement

Importance

Oral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life.

Objective

The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years.

Population

Asymptomatic children and adolescents aged 5 to 17 years.

Evidence Assessment

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years.

Recommendations

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement).

[Influence of systemic diseases on the diagnosis and treatment of dental diseases and prevention of related risks]

Patients with dental problems may suffer from various systemic diseases at the same time. The concomitant systemic diseases can have impacts and risks on the diagnosis, treatment planning and therapeutic practice in dentistry. The author briefly expounds the influences of systemic diseases on dental diagnosis and treatment and the prevention of risks from seven aspects: cardio-cerebral vascular system, blood system, respiratory system, endocrine system, digestive system, genitourinary system, nervous system and mental system, in order to provide references for the dental clinicians.

Clinically applicable artificial intelligence system for dental diagnosis with CBCT

In this study, a novel AI system based on deep learning methods was evaluated to determine its real-time performance of CBCT imaging diagnosis of anatomical landmarks, pathologies, clinical effectiveness, and safety when used by dentists in a clinical setting. The system consists of 5 modules: ROI-localization-module (segmentation of teeth and jaws), tooth-localization and numeration-module, periodontitis-module, caries-localization-module, and periapical-lesion-localization-module. These modules use CNN based on state-of-the-art architectures. In total, 1346 CBCT scans were used to train the modules. After annotation and model development, the AI system was tested for diagnostic capabilities of the Diagnocat AI system. 24 dentists participated in the clinical evaluation of the system. 30 CBCT scans were examined by two groups of dentists, where one group was aided by Diagnocat and the other was unaided. The results for the overall sensitivity and specificity for aided and unaided groups were calculated as an aggregate of all conditions. The sensitivity values for aided and unaided groups were 0.8537 and 0.7672 while specificity was 0.9672 and 0.9616 respectively. There was a statistically significant difference between the groups (p = 0.032). This study showed that the proposed AI system significantly improved the diagnostic capabilities of dentists.

Geriatric Ferrets

Ferrets are considered geriatric at 3 years of age. Twice-yearly physical examinations with additional testing finds problems and leads to prompt treatments that extend quality of life for the ferret. Bloodwork, urinalysis, dental examination, and imaging including radiographs and ultrasonography should be performed at least annually. Specialized testing includes echocardiography, electrocardiology, blood pressure, computed tomography scanning, and dental radiography depending on the ferret. Common problems include dental disease, cardiomyopathy, renal disease, musculoskeletal disorders, chronic gastrointestinal disorders, and neoplasias. Insulinoma, adrenal neoplasia, lymphoma, and skin tumors are commonly found neoplasias. Medical and surgical treatments and adjunctive complimentary therapies are discussed.

Emerging role of exosomes in craniofacial and dental applications

Exosomes, a specific subgroup of extracellular vesicles that are secreted by cells, have been recognized as important mediators of intercellular communication. They participate in a diverse range of physiological and pathological processes. Given the capability of exosomes to carry molecular cargos and transfer bioactive components, exosome-based disease diagnosis and therapeutics have been extensively studied over the past few decades. Herein, we highlight the emerging applications of exosomes as biomarkers and therapeutic agents in the craniofacial and dental field. Moreover, we discuss the current challenges and future perspectives of exosomes in clinical applications.

Optical Polarimetric Detection for Dental Hard Tissue Diseases Characterization

Dental enamel constitutes the outer layer of a crown of teeth and grows nearly parallel. This unique nanostructure makes enamel possess birefringence properties. Currently, there is still no appropriate clinical solution to examine dental hard tissue diseases. Therefore, we developed an optical polarization imaging system for diagnosing dental calculus, caries, and cracked tooth syndrome. By obtaining Stokes signals reflected from samples, Mueller images were constructed and analyzed using Lu-Chipman decomposition. The results showed that diattenuation and linear retardance images can distinguish abnormal tissues. Our result also aligns with previous studies assessed by other methods. Polarimetric imaging is promising for real-time diagnosing.

The oral biome in the aetiology and management of dental disease: Current concepts and ethical considerations

Our understanding of the complexity of the oral biome and of the role of the various constituent bacteria in the aetiology of dental disease is growing. Probiotics and their relationship with prebiotics, as well as other microbiome-based interventions, could be useful in preventing and treating dental disease and in promoting oral health. However, given the promise and early stage of this treatment approach, there are also a number of ethical, social and regulatory issues associated with innovative probiotic therapy. In this article, a brief update is given on contemporary theories of the aetiology and management of the two commonest dental diseases, and on the roles of pre- and probiotics and oral biome transplant in the management of these diseases. The focus is primarily on four core issues: informed consent, risk-benefit assessment, how to determine suitable healthy donors, and commercialization and regulation. We discuss the safety and benefits of oral probiotics, not only concerning the products and quality control during their manufacture, but also regarding the depth of public knowledge about this topic. We point out that the requirement of listing ingredients honestly might be insufficient, and that the prevalent rhetoric of 'natural' and 'organic' as well as some health claims in the translational, innovative probiotic industry and markets are themselves misleading and should be carefully scrutinized. Finally, we suggest an ethical imperative to find a balance between scientific research and industry, and public health in the regulation of probiotics.

Behavior guidance: that was then but this is now

Pediatric dentistry has evolved. Seasoned pediatric dentists believe that patients, parents, and behavior techniques have changed over their practice lifetimes. The purpose of this article is to provide dentists with a framework in which to adapt to the changes in society. Understanding cultural diversity, current societal values, technology and media influences, and contemporary parenting philosophies is essential to fostering communication with patients and their families. Building and honing behavior guidance skills are part of the process by which dentists help turn child patients into fearless adult patients with excellent oral health. This article reviews basic techniques and offers practical examples of implementing these in daily practice. The discussion also addresses changing parental and societal acceptance of various techniques and dentists' responsibility for informed consent regarding the risks and benefits of advanced behavior guidance techniques. Treating a patient from childhood to adulthood is the ultimate opportunity for the dentist to play a vital role in advancing the health and wellness of another human being.

ACTUAL ISSUES OF ODONTOGENIC MAXILLARY SINUSITIS (REVIEW)

Odontogenic maxillary sinusitis has now increasing incidence in dental and otorhynolaryngological practice. Its incidence varies from 10-12 % to 50-75 %, according to different authors. Literature study showed that odontogenic maxillary sinusites are mostly unilateral, and significantly differ in complaints, clinical signs, and diagnostic and treatment measures from other types of sinusitis. This should be taken into account, because often odontogenic maxillary sinusitis is misdiagnosed with common sinusitis, and only in 77 % such patients are examined by both dental specialist and otorhynolaryngologist. Study of causes of odontogenic maxillary sinusitis revealed that now iatrogenic impact prevails over other causes, which had been previously considered as main causes of odontogenic maxillary sinusitis. Especially endodontic treatment and implantation surgery are major causes of odontogenic maxillary sinusitis in present time, due to increasing incidence of perforation and damage of sinus by filling materials, bone or tooth particles, and implants. Anatomical structure of dental-sinus border area, and volume of endodontic treatment and implanting procedures, determines last ones as causative triggers due to development of complications and inflammatory processes. Microbial flora is mostly presented by anaerobic microorganisms; at the same time aerobic and fungal organisms are found in the microscopy of histology of patients with odontogenic maxillary sinusitis. At the same time, polymicrobial associations show high resistance to wide spectrum of antimicrobial medications. In past years theory of microbial biofilms is considered leading in explanation of recurrent and persistent odontogenic sinusitis. Such polymicrobial associations are covered with complex shield of different compounds, providing protection and nutrients. This significantly complicates treatments and can cause recalcitrant and recurrent infections.

Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions

OBJECTIVE

To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health.

DATA SOURCES

Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008-2010 State Inpatient Databases and State Emergency Department Databases.

STUDY DESIGN

Empirical analyses and structured panel reviews.

METHODS

Panels of 14-17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county-level poverty, uninsurance, and density of primary care physicians (PCPs).

PRINCIPAL FINDINGS

ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end-user panel separately rated the indicators as having strong face validity for most uses evaluated.

CONCLUSIONS

The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research.

Evidence-Based Advances in Rabbit Medicine

Rabbit medicine has been continuously evolving over time with increasing popularity and demand. Tremendous advances have been made in rabbit medicine over the past 5 years, including the use of imaging tools for otitis and dental disease management, the development of laboratory testing for encephalitozoonosis, or determination of prognosis in rabbits. Recent pharmacokinetic studies have been published, providing additional information on commonly used antibiotics and motility-enhancer drugs, as well as benzimidazole toxicosis. This article presents a review of evidence-based advances for liver lobe torsions, thymoma, and dental disease in rabbits and controversial and new future promising areas in rabbit medicine.

Adoption of dental innovations: The case of a standardized dental diagnostic terminology

BACKGROUND

Standardized dental diagnostic terminologies (SDDxTs) were introduced decades ago. Their use has been on the rise, accompanying the adoption of electronic health records (EHRs). One of the most broadly used terminologies is the Dental Diagnostic System (DDS). Our aim was to assess the adoption of SDDxTs by US dental schools by using the Rogers diffusion of innovations framework, focusing on the DDS.

METHODS

The authors electronically surveyed clinic deans in all US dental schools (n = 61) to determine use of an EHR and SDDxT, perceived barriers to adoption of an SDDxT, and the effect of implementing an SDDxT on clinical productivity.

RESULTS

The response rate was 57%. Of the 35 responses, 91% reported using an EHR to document patient care, with 84% using axiUm; 41% used the DDS. Fifty-four percent of those who did not use an SDDxT had considered adopting the DDS, but 38% had not, citing barriers such as complexity and compatibility.

CONCLUSIONS

Adoption of an SDDxT, particularly the DDS, is on the rise. Nevertheless, a large number of institutions are in the Rogers late majority and laggards categories with respect to adoption. Several factors may discourage adoption, including the inability to try out the terminology on a small scale, poor usability within the EHR, the fact that it would be a cultural shift in practice, and a perception of unclear benefits. However, the consolidation of the DDS and American Dental Association terminology efforts stands to encourage adoption.

PRACTICAL IMPLICATIONS

The successful adoption of dental innovation depends not only on the intrinsic merit of the innovation, as some useful innovations do not achieve widespread traction. As such, it is important for health care providers to understand how to disseminate their ideas in order to ensure traction and widespread adoption.

Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature

BACKGROUND

Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin.

METHODS

In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need.

CONCLUSIONS

Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

[Markers of dental children`s health in the application of therapeutic orthodontic equipment]

INTRODUCTION

Treatment of teeth anomalies using removable and non-removable orthodontic devices in children leads to complications such as caries, gingivitis, periodontitis, oral mucosa hyperplasia. Etiopathogenetical of these diseases can be associated with biochemical changes in the composition of saliva.

AIM

To determine the activity of lysozyme and amylase in oral fluid in children when using a fixed and removable orthodontic devices.

MATERIALS AND METHODS

Amylase and lysozyme were studied in oral fluid. Analyzed the biochemical composition of the freshly samples of oral fluid that was obtained in the control, experimental group 1 and 2 (children ages 7-18 years, which were used medical non-removable and removable orthodontic devices). Saliva was collected at the beginning of the therapeutic use of orthodontic devices (the first day of treatment), on 3 and 6 months of treatment. Assessment of lysozyme activity was carried nephelometric method on the ability of lysozyme to dissolve indicator organism Micrococcus lysodeicticus. To construct a calibration graph using dry lysozyme company Sigma. Salivary amylase activity was determined by hydrolysis of starch. The results were subjected to statistical analysis by standard methods. Data processed using software packages applied statistical analysis Statistica 6.0, Microsoft Excel, 2003.

RESULTS

The use of a fixed and removable orthodontic equipment led to a decrease in saliva amylase, major changes are observed on the 6th month of treatment. The activity of lysozyme in saliva decreased the mostin patients with a permanent equipment. Major changes were also recorded on the 6th month of treatment.

CONCLUSIONS

Complications of orthodontic treatment teeth anomalies in children (caries, gingivitis, periodontitis) caused by changes in the biochemical composition of saliva. For the prevention of the emergence and development of these complications is necessary to control the level of amylase and lysozyme in the mouth.

Acromegaly: A Dental Disease?

Acromegaly is a serious disease that affects the pituitary gland causing unusual growth in patients. There are various dental manifestation of the condition and it is plausible that a dentist will be the first to recognize the problem. This article describes the disease and the dental implications for patients who have it.

Retrospective Audit: Does Prior Assessment by Oral and Maxillofacial Surgeons Reduce the Risk of Osteonecrosis of The Jaw in Patients Receiving Bone-Targeted Therapies for Metastatic Cancers to the Skeleton?--Part II

Men who receive bone-targeted therapy for metastatic prostate cancer are at increased risk of osteonecrosis of the jaw (ONJ). Development of ONJ has been associated with the administration of bone-targeted therapies in association with other risk factors. ONJ can be distressing for a patient because it can cause pain, risk of jaw fracture, body image disturbance, difficultly eating, and difficulty maintaining good oral hygiene. The aim of this article is to report results of an audit of prior assessment by oral and maxillofacial surgeons (OMFS) before initiation of bone-targeted therapies and whether it may reduce the risk of ONJ in patients receiving bone-targeted therapies for advanced cancers.

[Is there interference between the manducatory apparatus and the postural system?]

Posturology is a specific area of theoretical and clinical physiology applicable in numerous fields of medicine and related disciplines and aims at studying the standing position and related dysfunctions. This functional medical approach offers a range of powerful multiprofessional diagnostic and therapeutic tools based on position-related neurophysiology and human movement in the management of a large number of pathologies. As posturologists, we frequently encounter disorders of the standing position due to one or several manducatory dysfunctions. However, conversely, it is also essential to be aware of why and how a postural syndrome can give rise to therapeutic failure in dentofacial orthopaedics. Drawing on the current state of knowledge, we intend to propose a protocol for diagnostic and therapeutic management making it possible to avoid Orthodontic and Dento-Facial-Orthopedic Failures defined as the "non-achievement of the expected results".

Conventional Therapy in Adults With X-Linked Hypophosphatemia: Effects on Enthesopathy and Dental Disease

CONTEXT

Treatment of X-linked hypophosphatemia (XLH) with active vitamin D metabolites and phosphate can partially correct skeletal deformities. It is unclear whether therapy influences the occurrence of two major long-term morbidities in XLH: enthesopathy and dental disease.

OBJECTIVE

The objective of the study was to investigate the relationship between treatment and enthesopathy and dental disease in adult XLH patients.

DESIGN

The study was designed as observational and cross-sectional.

SETTING

The study was conducted at an academic medical center's hospital research unit.

PARTICIPANTS

Fifty-two XLH patients aged 18 years or older at the time of the study participated in the study.

INTERVENTIONS

There were no interventions.

MAIN OUTCOME MEASURES

The number of enthesopathy sites identified by radiographic skeletal survey and dental disease severity (more than five or five or fewer dental abscesses), identified historically, were measured.

METHODS

Associations between proportion of adult life and total life with treatment and number of enthesopathy sites were assessed using multiple linear regression, whereas associations between these exposure variables and dental disease severity were assessed using multiple logistic regression. All models were adjusted for confounding factors.

RESULTS

Neither proportion of adult nor total life with treatment was a significant predictor of extent of enthesopathy. In contrast, both of these treatment variables were significant predictors of dental disease severity (multivariate-adjusted global P = .0080 and P = .0010, respectively). Participants treated 0% of adulthood were more likely to have severe dental disease than those treated 100% of adulthood (adjusted odds ratio 25 [95% confidence interval 1.2-520]). As the proportion of adult life with treatment increased, the odds of having severe dental disease decreased (multivariate-adjusted P for trend = .015).

CONCLUSIONS

Treatment in adulthood may not promote or prevent enthesopathy; however, it may be associated with a lower risk of experiencing severe dental disease.

Evaluation of the saliva cortisol levels in patients under prosthetic treatment due to functional disorders of the masticatory organ

One of the main etiological factors of the stomatognathic system dysfunction is stress and psychoemotional disorders. During stressful situations, there is an increase in the level of cortisol, the so-called stress hormone. Literature data indicate the existence of a correlation between blood cortisol levels and its amount in the saliva. This spurred an inspiration to undertake open, non-randomised studies, the objective of which was to conduct a comparative assessment of the saliva cortisol levels in patients with functional disorders of the masticatory system and in healthy volunteers, as well as to compare the results of cortisol levels with the results of survey-based tests with the use of Endler and Parker's CISS survey. Cortisol level was assessed due to its association with stress present in the body as one of the primary etiological factors of the stomatognathic system dysfunction, and hence the association of elevated cortisol levels assessed in the morning with the occurrence of dysfunctions of the stomatognathic system. The subject of the study is a group of 30 patients, of both sexes, aged between 20 and 46, who reported to the Dental Prosthetic Out-Patient Clinic of the Institute of Dentistry, Jagiellonian University in Cracow, for prosthetic treatment due to the painful form of functional masticatory organ disorders. The control group consisted of 30 subjects, aged between 19 and 41, in whom dysfunctions of the stomatognathic system were excluded. Collection of saliva for testing was performed at a fixed hour (9 am) into plastic test tubes with a stopper. Immediately after collection, the saliva was frozen at the temperature of -18 °C. The assessment of the cortisol levels was conducted by the high performance liquid chromatography (HPLC) with UV detection at the Department of Analytical Chemistry, Faculty of Pharmacy, Department of Laboratory Medicine of the Gdansk Medical University. Moreover, a 20-minute psychological test was conducted with the use of the CISS (coping inventory for stressful situations) survey in order to assess the patients in terms of their abilities to cope with stressful situations. The results obtained were submitted to a statistical analysis based on the conventional calculation procedures. The test group revealed significantly higher cortisol levels compared with the results obtained by the control group. The findings of the CISS survey confirmed the predominance of the emotion-focused strategy of coping with stressful situations in the test group. The results support the view that the psychoemotional factor is, to a considerable extent, conducive to the development of functional disorders. The elevated cortisol levels in patients with psychological disorders concur with the findings by other authors. The results obtained confirm that psychoemotional disorders may be one of the etiological factors of the stomatognathic system dysfunctions. The CISS survey, which was not used in similar studies before, makes it possible to obtain information on the subject's method of coping with stress, thus allowing for the initiation of a relevant psychological therapy aiding the prosthetic treatment.

Two Cases of Liver Abscesses Derived from Dental Disease in Patients with Alcoholic Chronic Pancreatitis

Among the etiologies of pyogenic liver abscess (PLA), bacterial spread from the biliary tract or portal flow is the major cause, while the onset of PLA due to arterial bacterial transmission is rare. We herein report two cases of PLA thought to be caused by arterial transmission from dental disease. In both cases, there was benign biliary stricture as a result of alcoholic chronic pancreatitis, although normal oral flora was detected as the causative bacteria and oral hygiene was poor in both patients. We presumed that the origin of PLA was dental disease and successfully treated the patients with percutaneous drainage, antibiotics and dental procedures.

Computer-Aided Diagnoses of Chronic Head Pain: Explanation, Study Data, Implications, and Challenges

The differential diagnosis of diseases and disorders having head pain as a symptom is often a difficult challenge for health care professionals. The complexity of this problem, the need for computer aided diagnosis, and the assumptions upon which one diagnostic software program was developed are discussed. A database driven user-oriented Internet website was offered at no charge to headache sufferers, and this vehicle provided the data source for research. The software program compares consistent user surveys to 253 expert profiles compiled from searches of the best available material in the medical/dental literature. A database of 1288 consistent user surveys was studied and analyzed for this paper. Findings discussed are: 1. the large amount of users (63%) who do not match any expert profile to a reasonable degree of medical certainty; 2. the significance of the relatively large amount of headache sufferers (17%) whose diagnosis or diagnoses are solely within the realm of dentistry; and 3. the importance of differentiating between discriminating and substantiating diagnostic criteria. Many users do not fit existing algorithms for chronic head pain. Data generated by this computer-aided diagnostic software program challenge some current paradigms and concepts of diagnosis. The data generated question "correct to a reasonable degree of medical certainty," challenge "a preponderance of the evidence" as scientific diagnostic standards, and also question whether rendering a working diagnosis is possible on each and every patient.

[Oral infections]

In the survey the basic aspects of the infectious pathology are analyzed, that are to be met in the work of stomatologist. There is in detail described the intra-hospital infection, caused by conditionally pathogenic flora. There is given the clinical characteristics of the oral manifestations of the basic of <<traditional>> infectious diseases.

[Dental screening in patients with rheumatic disease]

Dental screening features of patients having rheumatic diseases are reviewed concerning such factors as examination and oral hygiene sessions frequency, specific rheumatic disease (rheumatoid arthritis, system lupus erythematosus and systemic sclerosis), oral and dental disorders (periodontal disease, dental caries, salivary glands disorders).

[Evaluation of soft tissue lesions affecting the masticator space with dynamic contrast enhanced MRI]

OBJECTIVE

To determine the characteristics and diagnostic value of dynamic contrast enhanced MRI (DCE-MRI) in differentiating benign soft tissue lesions from malignant tumors affecting the masticator space (MS).

METHODS

Prior to managements, conventional MRI and DCE-MRI were performed in 53 patients who suffered from primary or secondary soft tissue lesions affecting the MS. The time to peak (TTP), relative maximum enhancement (RME) and relative washout ratio (RWO) were separately calculated.

RESULTS

Mean TTP of benign and malignant lesions were (130.3 ± 13.2) and (69.6 ± 6.9) s, respectively. Mean RWO of benign and malignant lesions were (29.7 ± 5.5)% and (8.7 ± 2.1)%, respectively. Malignant lesions had a significantly shorter TTP(P = 0.001) and lower RWO (P = 0.003) than benign lesions. When TTP was less than 92.2 s and RWO less than or equal to 16.0%, malignant tumors were considered. DCE-MRI had a sensitivity of 72.3%, specificity of 93.5%, accuracy of 84.9%, positive predictive value of 88.9%, and negative predictive value of 82.9%.

CONCLUSIONS

As a non-invasive imaging technique, DCE-MRI is valuable to differentiate benign soft tissue lesions from malignant tumors affecting the MS.

"Training teeth": transitional resin bonding for diagnostic purposes

Despite the best diagnostic efforts, the etiology of a patient's dental disease may remain elusive. Without knowing the underlying disease factors, predictable outcomes are difficult to obtain. This case report describes the diagnosis and treatment of a patient who felt embarrassed by the appearance of his smile and was desperately seeking a solution. Despite meticulous data collection and a systematic diagnostic approach, the disease etiology could not be determined. It was, therefore, decided to treat the patient with non-invasive transitional directly bonded composite to road test his new teeth. In this way, a determination could be made as to whether they would function successfully over time.

The absolute contraindication for using nitrous oxide with intraocular gases and other dental considerations associated with vitreoretinal surgery

Nitrous oxide is absolutely contraindicated after vitreoretinal surgery that uses intraocular gas, as the mixture of gas and nitrous oxide can cause catastrophic vision loss. Professional awareness and communication are vital to prevent this iatrogenic complication. This case report identifies a side effect of vitreoretinal surgery with a benign outcome--specifically, a referred pain or pressure from left eye surgery or an associated gas bubble to the upper left quadrant. Such cases underscore the need for a dentist and staff to inquire about all ocular procedures to avoid patient vision loss due to nitrous oxide. Dentists should communicate with the patient's opthalmologist before proceeding with any dental procedure.

SELF-ASSESSED DENTAL HEALTH KNOWLEDGE OF NIGERIAN DOCTORS

OBJECTIVES

To assess medical doctors' knowledge of common dental diseases and the need to include dental education in the Nigerian undergraduate medical curriculum.

DESIGN

Cross-sectional multicentre non-random survey using a convenience sample.

SETTING

Tertiary hospitals across two geo-political zones of Nigeria. Participants were mostly recruited while attending seminars and other departmental events which brought doctors together.

SUBJECTS

Medical doctors in tertiary hospitals across two geo-political zones of Nigeria.

MAIN OUTCOME MEASURES

Knowledge of common dental diseases namely, dental caries, gingivitis and periodontitis was evaluated using an open-ended questionnaire. The definition, etiology, treatment and age-related risk were assessed. Exposure to dental education during undergraduate training was assessed. Opinion on desirability and suggested length of future training were also assessed.

RESULTS

A total of 127 doctors (35 interns, 30 residents, 34 senior residents and 28 consultants) participated in the study. Overall, knowledge of definition, etiology, treatment and relative prevalence were recorded. About 69 doctors (54.3%) correctly defined dental caries, 120 (94.5%) correctly defined gingivitis while only only 29 (22.8%) correctly defined chronic periodontitis. The proportions of respondents who correctly identified disease etiology were 26 (20.5%) for caries, 31(24.4%) for gingivitis and 12 (9.4%) for chronic periodontitis. The proportions of respondents who correctly identified appropriate treatment modalities were 39 (30.7%) for caries, 18 (14.2%) for gingivitis and 6 (4.7%) for periodontitis. Those who correctly identified the relative, age-related prevalence of the three diseases were 81 (63.8%) for caries, 51 (40.2%) for gingivitis and 47 (37%) for periodontitis.

CONCLUSION

Most of the medical doctors who participated in the study demonstrated inadequate knowledge of common dental diseases and about 97% of respondents supported the idea of including dental education into the current Nigerian undergraduate medical curriculum.

MBGR protocol of orofacial myofunctional evaluation with scores

The MBGR Protocol with scores was first published in 2009. This protocol was widely administered by speech-language pathologists experienced in orofacial myology in different states from Brazil for four months. From the comments and suggestions of these professionals, the protocol was reviewed and modified. A consistent visual training materials program was prepared, and speech-language pathologists, experienced in orofacial myology from different states of Brazil, Venezuela, Peru, and Colombia were trained with the provided materials. These speech-language pathologists administered the protocol for two years. From the data collected by the speech-language pathologists, modifications were made, and a final version was designed. This final version was administered for two-months by the same speech-language pathologists from Brazil, Venezuela, Peru, and Colombia in order to re-test the final version of MBGR protocol. The aim of this study was to demonstrate the efficiency and effectiveness of the protocol to assess orofacial myofunctional alterations. The final version of the MBGR protocol with scores has proven to be efficient and effective in the identification of individuals experiencing orofacial myofunctional disorders.

The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

Sample of a client intake information protocol: a synopsis and rationale

The utilization of standardized comprehensive forms in the field of orofacial myology is crucial as this profession continues to grow and establish assessment and treatment protocols. This article formally presents a comprehensive health history intake form currently in use, and highlights the rationale for each particular question within this form in an effort to explore the evidence-based theory behind each question utilized. Highlighting the importance of obtaining a thorough health history as it pertains to our profession, personally allows the clinician to ultimately best plan a therapeutic strategy and assess the individual criteria necessary for successful orofacial myofunctional habituation.

A one-page orofacial myofunctional assessment form: a proposal

The author presents her own proposal of a one-page orofacial myofunctional assessment and for each item on the list a brief rationale is provided. The protocol is an easy but comprehensive form that can be faxed or emailed to referral sources as needed. As science provides more objective assessment and evaluation tools, this one-page form can be easily modified.

[Congenital insensitivity to pain: difficulty of management]

INTRODUCTION

Congenital insensitivity to pain with anhidrosis (CIPA) is a very rare disorder, most often of genetic origin.

CASE REPORT

The authors present the case of two siblings, 10 and 13 years old, both followed-up since the age of 2 for CIPA diagnosed after discovering insensitivity to pain during iterative falls, burns, and of severe oro-digital self-mutilating behavior. Sural nerve biopsy and an electromyogram confirmed the diagnosis.

DISCUSSION

CIPA with anhidrosis is a very rare disease. It is characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and sometimes mental retardation. Complications of this insensitivity (non-treated fractures, burns, and oro-digital mutilation) may be lethal. Treatment remains preventive. The patient must observe a very strict hygiene. Prevention for maxillofacial involvement consists in breaking the cycle of oral self-mutilation.

[The results of medicolegal proceedings involving dental care services]

The paper deals with the results of medicolegal proceedings involving inappropriate dental care service in both criminal and civil cases. The authors also propose measures for prevention of pitfalls described in the study.

[The stomatologic complications arising after carrying out of complex treatment of malignant formations of the oral cavity and pharynx (correction for drinks)]

Complex treatment of malignant tumors of an oral cavity and a throat includes basically a combination of surgical, beam and chemotherapeutic methods of treatment. All listed components of treatment applied in the field of a head and a neck, lead to development of stomatologic complications. Arising complications, accumulating against each other, cause symptoms of mutual burdening. Correction of the given conditions entirely to lay down on the doctor-stomatologist. Article is devoted the analysis of arising complications, and their influence against each other.

[An update on focal infection of oral origin]

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.

The influence of systemic diseases on the diagnosis of oral diseases: a problem-based approach

Although all dentists are taught about the importance of oral health to general health and that systemic disease can manifest in the oral cavity, the 4-year dental school curriculum does not allow time to gain competency in these relationships. Nevertheless, all dentists must have skills in taking a medical history and an appreciation of oral findings that might have a systemic origin. This article focuses on the identification of abnormal signs and symptoms in the oral cavity and the determination of those that have a systemic origin. It is imperative that clinicians are mindful of the possible oral-systemic associations, because these could potentially have a huge impact on patient care.

[Results of dental implantation in elderly patients]

In absence of contraindications, with competent planning and complex oral mouth treatment and adequate use of surgical and orthopedic protocols, the dental implantation could be successfully implemented for esthetical and functional rehabilitation of elderly patients with different forms of adentia. Dental implantation can significantly increase the quality of life of elderly patients.

[Investigation of stomatologic status of middle-aged and elderly people in Western Georgia]

The world's population is aging at an accelerated rate. People aged 65 and over now comprise a greater share of the world's population than ever before, and this proportion will increase during the 21st century. Increased lifetime in old age is combined with a concern about its quality. Oral health care of the elderly is one of the important aspects affecting the quality of life. The aim of the present study was to describe stomatologic status among middle-aged and elderly people in western Georgia. 355 subjects aged 55-90 years old were surveyed. According to oral health survey data, a high prevalence and intensity of dental caries and periodontal disease were apparent. Prosthetic status and treatment need were recorded in standard condition using oral health assessment forms. It is concluded that a high percentage of elderly were dentate but the average number of teeth was low and their status was poor, with very high need for therapeutic and prosthetic treatment.