Ten-year trends in DMF-S and DMF-T in a northeast German adult population

OBJECTIVE

The aim of this study was to assess 10-year trends in coronal caries in adults aged 20-83 years using data from the two-representative population-based Studies of Health in Pomerania (SHIP-0/SHIP-Trend-0).

METHODS

Repeated cross-sectional data from 4,286 SHIP-0 and 3,913 SHIP-Trend-0 participants were analysed. Carious, filled and missing teeth/surfaces were recorded in a half-mouth design and the DMF-T/S scores and sound surfaces/teeth were calculated according to WHO criteria. Trends in DMF-T/S scores and its single components were presented stratified by age group and sex.

RESULTS

A statistically significant decline in coronal caries experience (DMF-T and DMF-S) in adults aged 20 to 83 years as well as for D-T/S components was observed. The proportion of edentulous participants was almost halved from 8.7% (SHIP-0) to 5.1% (SHIP-Trend-0), while the number of M-T declined from 4.4 to 3.5 revealing an overall clear shift to a higher retention rate of teeth. In younger adults (25-34 years) 3.8 more sound teeth (17.2 sound surfaces) were found in average in the mouth and in elderly (65-74 years) a clear shift from extracted to filled teeth was observed (M-T reduced by 5.4, while F-T increased by 4). Regarding sex differences, females had consistently on average higher MF-T/S values, but lower D-T/S values than males.

CONCLUSION

A clinically relevant drop in the severity of coronal caries experience in all adult age groups in Northeast Germany shows that not only reductions in caries experience in adolescence translated into adulthood but also later improvements led to long-term oral health.

Long-term evaluation of three-dimensional volumetric changes of augmented severely atrophic maxilla by anterior iliac crest bone grafting

PURPOSE

The purpose of this study was to evaluate long-term three-dimensional graft resorption following reconstruction of the severely atrophic maxilla with anterior iliac crest bone grafting.

METHODS

Twenty-two patients (13 males), who underwent autogenous bone grafting and implant placement to their severely atrophic maxillary alveolar ridges were identified and included in the study. Pre- and postoperative cone-beam computed tomography (CBCT) scans of 40 recipient grafting sites were evaluated to calculate volumetric changes over time. CBCT scans were performed preoperatively (V0) and one week (V1), three months (V2), one year (V3), and three years (V4) following the augmentation operation.

RESULTS

The average graft resorption from V1 to V2, V1 to V3, and V1 to V4 was 31.42%, 33.96%, and 37.96%, respectively. Initial graft volume reduction within the first three months was statistically higher compared to other postoperative periods (P<0.013). The rate of resorption reduced slightly from the third month of the surgery (V2) (P>0.013). There was no statistical difference between resorption volume and gender, type of prosthesis, the presence of vestibuloplasty, or patient age (P>0.05).

CONCLUSION

The overall success rate of the iliac bone block grafts was found to be high. The volumetric resorption rates associated with the graft were favourable for the reconstruction of the maxilla and for permitting the placement of dental implants three months after augmentation. The highest graft resorption was found at the third postoperative month. Placement and loading of the implants reduced the resorption rate slightly over time.

Development of a financially viable model for the management of mandibular fractures as day cases in a level 1 major trauma centre

There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits. Inpatients were assessed for day surgery using medical, social, and surgical criteria. Each patient's suitability for discharge was assessed two, three, and five hours postoperatively. A financial feasibility study was made retrospectively on a larger sample of patients with mandibular fractures. The discharge criteria from the day-care unit were fully met by 26/40 patients at five hours postoperatively, mean (range) duration of operation was 145 (40-285) minutes, and mean (SD) Mandibular Injury Severity Score was 13 (3), range 7-20. When all the criteria were combined (n=100), 12 of the patients were suitable for day care. With 24 bed-day savings/100 patients, potential earnings would increase to around £80 000/year at this hospital. In conclusion, we have identified a group of patients who were suitable for management of mandibular fractures in the day-care unit. Considerable cost savings are anticipated.

Implementation of an oral and maxillofacial surgery trauma team in a major trauma centre

In 2010, King's College Hospital in London was designated as a major trauma centre. To deal with the increasing number of patients, an integrated oral and maxillofacial team of the week was established in 2012 to provide a consultant-led, emergency service dedicated to acute care, and it was anticipated that this would reduce the duration of stay by 0.3 bed-days. To assess the effect of the new system, we compared the duration of stay between 1 October and 31 January 2011-2012 with the same period in 2012-2013. We also assessed the activity and training of registrars, and the department's perception of the post of trauma registrar. The mean total duration of stay had decreased significantly by 0.84 days (p=0.03), the mean delay to operation had decreased by 0.3 days, and the mean postoperative stay had decreased by 0.5 days. During one week, the trauma registrar did 12 operations at various sites in the hospital. The new system was a cost-effective way of improving emergency OMFS care and it can be recommended to other centres with similar profiles.

The role of diffusion-weighted magnetic resonance imaging in the diagnosis, lymph node staging and assessment of treatment response of head and neck cancer

Standard magnetic resonance imaging (MRI) and computed tomography continue to be the imaging modalities of choice in staging and reviewing patients with head and neck cancer. Diffusion-weighted MRI (DW-MRI) is an advanced imaging modality that records the molecular diffusion of protons and thus provides an opportunity to further assess tissue character. Interest in DW-MRI of the head and neck continues to grow, especially its application to the assessment and treatment of head and neck cancer. We highlight the potential role of DW-MRI in the delineation, characterization, and lymph node staging of head and neck tumours. Furthermore, we discuss the ability of DW-MRI to provide a real opportunity to differentiate post-treatment tumour recurrence from chemoradiotherapy-induced local tissue changes. The future impact of these findings upon the clinical practice of the head and neck surgeon is discussed.