Relevance of anterior mandibular body ostectomy in mandibular prognathism.

PURPOSE: We tried to find out the relevance of anterior mandibular body ostectomy in deformities of the mandible specially prognathism, which is primarily limited to anterior part only. PATIENTS AND METHODS: Ten patients with skeletal deformity along with malocclusion, which was limited to anterior body of mandible were selected. Selected patients had proper molar interdigitation (even if class 3) and in general had anterior crossbite (except one). All patients had crossed their growth spurts and had no hormonal influence on facial deformity. Specific protocol, including cephelometric analysis cephalometry for orthognathic surgery, prediction tracing and model surgeries were devised. Pre and post-surgical orthodontics and body ostectomy were performed in all patients along with 18-month post-op follow-up. RESULTS: There was significant reduction in prognathism and horizontal dysplasia in all ten patients. Anterior crossbite as well as axis of incisiors over mandibular plane was corrected in all patients due to decrease in length of mandibular body. All patients showed decreased facial height and better lip competence with intact posterior occlusion and no (negligible or transient) sensory loss. CONCLUSIONS: Our study could confirm that people whose deformity is limited to the anterior part of mandible with reasonable occlusion posteriorly can get satisfactory cosmetic and functional results through body ostectomy alone rather than going for surgical procedure in the ramal area, which is liable to cause sensory and occlusal disturbances.

Drug susceptibility pattern of Mycobacterium tuberculosis isolates from patients of category-II failure of pulmonary tuberculosis under directly observed treatment short-course from north India.

The major contributing factors for the causation of treatment failure in cases of pulmonary tuberculosis under Category-II directly observed treatment short-course treatment (DOTS) are treatment after default, poor treatment compliance, and development of multi-drug resistant (MDR) tuberculosis. The objective of the present study is to find out the demographic profile and drug susceptibility pattern in Category-II failure patients of pulmonary tuberculosis under Revised National Tuberculosis Control Programme (RNTCP) of India. Two hundred and twenty four patients with Category-II treatment failure of pulmonary tuberculosis were enrolled from Department of Pulmonary Medicine, at Chatrapati Sahuji Maharaj Medical University, UP, Lucknow, India, from August 2003 to July 2008. Their complete bacteriological assessment in terms of sputum smear for acid-fast bacilli, culture for Mycobacterium tuberculosis and drug sensitivity pattern were done in the Department of Microbiology. Among 224 patients, 16 (7.1%) patients were lost to follow-up and the final analysis was done among 208 (92.8%) cases. The reasons for inclusion of these 224 cases in the Category II regimen were treatment failure in the previous regimen (n = 75, 33%), default in 57% (n = 129 cases), and relapse in 8.9% (n = 20 cases). Among 208 patients, culture was positive in 170 (81.7%) cases, negative in 17 (8.1%) cases and contaminated in 21 (10%) cases. The drug sensitivity pattern of culture positive cases of Category-II failure patients revealed that, 58.2% (n = 99) had MDR tuberculosis and 40.5% (n = 69) were resistant but were non-MDR tuberculosis and 1.1 % (n = 2) cases were sensitive to all first line antituberculosis drugs.

The effect of wound dressings on the pH stability of fluids.

Wound healing is a complex process that is influenced by both intrinsic and extrinsic factors, and it is becoming increasingly complex with the latest treatment methods and investigations of wound nature. The term 'wound healing' covers all types of wounds, burns and ulcerations. There is a considerable global variation in the treatment of acute and chronic wounds, therefore, establishing a standardised, best way to manage wounds may not be possible. Complete wound healing, which includes restoration of function, is hardly ever achieved in those disfigured by wounds, especially when one includes the appearance of scarred skin or an amputation.

Possible relationship between periodontitis and dementia in a North Indian old age population: a pilot study.

BACKGROUND: Periodontitis and cognitive impairment or dementia is relatively common among older adults. Few cross-sectional studies and some longitudinal studies have attempted to link oral health with dementia diagnosis or disease pathology but none has investigated the role of inflammation as a potential mediator. OBJECTIVES: This study was planned to establish a relation of inflammatory mediators between periodontitis and dementia. MATERIALS AND METHODS: Fifty-five patients with severe periodontitis (range 60-69 years), 20 with dementia (10:10 M:F; range 59-69) and 32 healthy controls (range 58-69 years) were selected. The socio-demographic characteristics, physical health, oral health, education status, and medical status were measured. Serum C-reactive protein (CRP), matrix metalloproteinase (MMP)-8, MMP-9, total IGF-I, free IGF-I and TNF-alpha and GCF MMP-8 &MMP-9 were calculated. RESULTS: There was no significant difference between the three groups in the level of education, age, occupation, BMI, CAD, CHF and diabetes except dentate status. After adjusting for age, significant differences were found between patients and controls with respect to gingival inflammation, dental plaque, bleeding on probing and probing pocket depth. Total counts of WBCs, neutrophils, thrombocytic counts and serum CRP, MMP-8, MMP-9, TNF-alpha levels were significantly higher in dementia and periodontitis patients in contrast to healthy controls, while, RBC counts, total IGF-I and Hb levels were lowered in dementia and periodontitis patients in comparison to healthy controls, although higher in dementia as compared to periodontitis patients. CONCLUSIONS: This study data suggest a relationship of inflammatory mediators between periodontitis and dementia. Further exploration of this is warranted.

Effect of simulated microgravity on salivary and serum oxidants, antioxidants, and periodontal status.

BACKGROUND: Microgravity is associated with an increase in peroxidative damage. The effect is more pronounced after long-duration space flights and can even last for several weeks after landing. The objective of the study is to determine the influence of simulated microgravity on the periodontal status and salivary and serum oxidant/antioxidant status of the body in simulated microgravity (-6° head-down-tilt [HDT) bed rest). METHODS: Twenty healthy male volunteers were studied before and after 60 days of simulated microgravity (-6° HDT bed rest). We measured salivary and serum oxidative markers, such as malondialdehyde (MDA), 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG), and vitamins C and E, and clinical periodontal parameters (probing depth [PD] and clinical attachment level [CAL]). RESULTS: Serum and salivary vitamin C and E concentrations were significantly decreased, whereas MDA and 8-OHdG levels were significantly increased after 60 days of simulated microgravity. Serum and salivary markers showed a strong and significant correlation. CAL and PD were higher but not statistically significant in simulated microgravity. CONCLUSIONS: This study suggests that oxidative stress in the microgravity environment was increased but did not significantly influence periodontal parameters after 2 months. Also, this study indicates the possibility that the findings may have a broader clinical relevance to patients on bed rest or who are physically inactive. Studies on larger patient samples and follow-up for a longer time are required to verify the relationship between antioxidant status in the space microgravity condition and periodontal health.

Salivary stress markers, stress, and periodontitis: a pilot study.

BACKGROUND: Some cross-sectional and longitudinal studies attempted to link periodontitis with stress. To our knowledge, only one small study was published on the mechanism by which stress may influence periodontal diseases, suggesting behavioral and physiologic mechanisms and investigating the role of inflammation as a potential mediator. The present study is planned to explore the associations among periodontal disease, psychologic factors, and salivary markers of stress, psychoneuroimmunologic variables, and health behaviors. METHODS: One hundred periodontitis patients were selected, and participants provided information on general health, chronic stress, and demographics. Stress markers (choromogranin A, cortisol, α-amylase, and ß-endorphin) were measured from saliva. A dentist assessed the presence of dental plaque on lingual and buccal surfaces, the gingival index, and the number of remaining teeth with periodontal disease. RESULTS: Stress and salivary stress markers were significantly correlated with clinical parameters of periodontal disease (ranging from 0.19 to 0.59; P <0.001). Neglecting to brush teeth during stress was associated with missing teeth. After adjusting for stress variables, salivary cortisol and ß-endorphin were significantly associated with tooth loss and periodontal clinical parameters (P <0.001; R(2) = 0.59). CONCLUSIONS: This study suggests that stress might be associated with periodontal disease through physiologic and behavioral mechanisms. In making diagnoses of psychiatric patients, the association between salivary stress markers and periodontal disease needs to be included. Further exploration of relationships between periodontitis and stress is warranted.

The effect of smoking on gingival crevicular fluid levels of myeloperoxidase.

OBJECTIVES: To compare the gingival crevicular fluid (GCF) myeloperoxidase (GM) levels in smokers and non-smokers. MATERIALS AND METHODS: This study comprised 45 subjects: (a) 12 smokers with periodontitis, (b) 10 non-smokers with periodontitis, (c) 11 smokers with healthy periodontium, and (d) 12 non-smokers with healthy periodontium were recruited for the study and their GM levels were analyzed. RESULTS AND CONCLUSION: GM levels were significantly higher in smokers with periodontitis compared with others. Hence, more incidence of mutagenesis and cytotoxicity were noted at sites of inflammation mediated by GM in smokers compared with non-smokers.

Are biopolymers potential deodourising agents in wound management?

OBJECTIVE: To investigate the odour-adsorbing properties of biopolymers, with a view to using the findings to develop a novel dressing with odour-adsorbing properties. METHOD: The odour-adsorbing properties of a selection of biopolymers (aloe vera, tea tree oil, neem oil and manuka honey) and three commercially available dressings containing activated charcoal cloth (ACC) were quantitatively assessed using laboratory test equipment. An aloe vera-containing composite dressing, designed and developed by the authors, was also compared with the ACC dressings. RESULTS: Aloe vera was the most adsorbent of the biopolymers and a 40% dilution had comparable values to those of the ACC dressings. Furthermore, values for the novel composite dressing were similar to those of the ACC dressings. CONCLUSION: The novel composite dressing may be a potential alternative to ACC dressings, and has the added advantages of having antimicrobial properties as well as the ability to promote a moist wound environment. However, more research is needed.

Accuracy of BR regression equation for impacted teeth in age estimation in Haryana population of India.

Dental cementum is a vital tissue that demonstrates continuous apposition throughout the life of a tooth. Positive correlation has been reported between the coronal displacement of cementum and age in impacted teeth and BR regression equation has been proposed. The present study is an attempt to calculate accuracy of BR regression equation in Haryana population of India. The study was conducted on 20 impacted mandibular third molars extracted from healthy patients, aged between 22 and 32 years. The bucco-lingual ground sections were prepared and the distance between the edges of enamel and cementum were measured with micrometer attached to a light microscope and BR regression equation was applied for age estimation. Although the estimated age with BR regression equation was less than chronological age it was not statistically significant. Hence, the BR regression equation can be used in medicolegal as well as in forensic odontology for age estimation.

Mandibular third molar development staging to chronologic age and sex in north Indian children and young adults.

Age estimation is not only important for clinical but also for medico-legal purposes. The present study is an attempt to estimate the chronologic age based on the stages of third molar development following the eight stages (A-H) method of Demirjian et al8 and to compare third molar development by sex and age. We examined 250 orthopantomograms of young north Indian subjects of known chronologic age (range, 7-26 years). Statistical analysis was performed using the Mann-Whitney U-test and the Wilcoxon test between sex and age. Regression analysis was performed to obtain BR regression formulae for dental age calculation with the chronologic age. Statistically significant differences in mandibular third-molar development between males and females were revealed regarding the calcification stages D and G. The results further indicated that third-molar formation was attained earlier in females than in males. Statistical analysis showed a strong correlation between age and third-molar development for both the sexes.

Technical note: Age estimation from mandible by lateral cephalogram: a preliminary study.

Age estimation is an important aspect of forensic investigation and is considered as one of the "Big Four" of Forensic Anthropology. One hundred and twenty (120) cephalograms of individuals aged 7-20 years were examined with reference to mandibular body length (distance between Gonion and Gnathion) mandibular length (distance between Co and Gn) and mandibular height (distance between Co and Go). An attempt has been made to assess the utility and dependability of these three linear parameters for age estimation. The mandibular body length, ramus height and mandibular length were increased by 2.23, 3.26, 4.26 mm/years respectively. There are no significant differences in mandibular linear growth between the two sexes though the female mandible has a higher growth rate compared to males. These parameters might prove to be of importance in age determination for medico-legal purposes.

Salivary vitamins E and C in oral cancer.

Lipid peroxidation may be involved in cancer and essential nutrients that can scavenge free radicals, such as vitamins E and C, operate in concert. Levels of antioxidant vitamins E and C were estimated in 50 patients with oral cancer and 24 healthy persons served as control. Significantly lower levels of vitamins E and C were observed in oral cancer patients as compared to controls (P < 0.011). Antioxidant nutrients may be utilized to a greater extent in oral cancer patients to counteract free radical-mediated cell disturbances, resulting in a reduction in salivary antioxidant levels.

Venous leg ulcer treatment and practice--part 1: the causes and diagnosis of venous leg ulcers.

This article, the first of a series of four on venous leg ulceration, discusses theories relating to the pathophysiology underlying the condition, and the range of diagnostic procedures undertaken to establish that ulceration is of venous origin.

Health-related quality of life tools for venous-ulcerated patients.

Healthcare manufacturing companies have developed many new and novel materials for wound care. They claim that the dressing materials will improve the healing progress of the wound or have a therapeutic value and have sought to assess their efficacy and effectiveness in clinical trials. These claims should be clearly supported by the perspectives of those who actually use the devices. Compression therapy, which is regarded as an effective treatment for venous leg ulcers, is far from ideal owing to a number of limitations that it possesses, such as patient discomfort, difficulty experienced in applying correct compression on the limbs, choosing a correct dressing for the wound or finding differences between the performance of various devices. It is necessary to investigate the patient's views and perspectives while randomized controlled clinical trials are conducted. In this review the concept of quality of life (QoL) and the tools used to measure QoL and studies that were conducted with patients suffering from chronic venous leg ulcers and undergoing therapy are considered, along with contributory factors to the healing process. In addition, a questionnaire modified from the original format is recommended as the suitable tool for assessing the QoL of patients suffering from venous leg ulcers while participating in clinical trials.

Advanced wound care materials: developing an alginate fibre containing branan ferulate.

OBJECTIVE: This laboratory-based study set out to establish whether branan ferulate--a polysaccharide compound available in gels such as as Sterigel (SSL International, UK)--could be successfully added to the fibre of an alginate dressing to provide a superior wound-care dressing. METHOD: A wet extruder (Howden Engineering Services, UK) was used to produce the fibres. Researchers examined the effect of spinning-bath calcium chloride concentration (used as the coagulant in the fibre-spinning process) on the tensile and absorption properties of alginate fibres containing 25% w/w branan ferulate. Sodium alginate and branan ferulate were separately dissolved in de-ionised water and then stirred together to make up a 5% dope solution. The dope was then forced through a spinneret and into the calcium chloride bath, where fibres were precipitated and then carried over the first set of rollers. The fibres were washed in the next bath and drawn at different rates to enhance their tensile properties. At the 'winding-up' stage the filaments were either passed over a contact heater and into a furnace (dry pick-up) or transferred into acetone baths of increasing concentrations of 50, 80 and 100% aqueous acetate to remove the water (wet pick-up). The moisture content of standard alginate fibres and those with branan ferulate were measured and compared. Breaking load, tenacity and breaking extension, and the quantity of branan ferulate in the fibres were also measured. The process was repeated four times, using different strengths of calcium chloride. Using various draw ratios, the effects of liquid uptake were measured using water, saline and a solution called A (to mimic human blood and exudate-type fluids). RESULTS: Out of the four calcium chloride concentrations used, 1% concentration appeared to give the highest and most conclusive results for fibre-breaking load, tenacity and breaking extension. CONCLUSION: A 1% w/v concentration of calcium chloride provides the optimum conditions for achieving suitably strong fibres with adequate absorption capacity, while allowing the least branan ferulate loss during wash and post-production treatments. In a laboratory setting the product showed promise. Research is now needed in a clinical setting and for comparison with existing wound-care products.

Insight into the development of non-adherent, absorbent dressings.

OBJECTIVE: This study aimed to develop a variety of wound dressing materials, made from standard natural fibres, that have high absorption and non-adherent characteristics. METHOD: A total of 21 dressings were made using knitted and crochet technologies and their absorbency was tested. Five non-adherent recipes were selected from a range of chemical formulations and the optimised non-adherent finishes were applied to the four best dressings. Their absorbency and non-adherent properties were evaluated. RESULTS: The study demonstrated that rib cotton (RC), rib viscose (RV), crochet cotton medium (CCM) and crochet viscose medium (CVM) dressings possess high absorption and that five finishing recipes, C + D, A + G, I, I + N and I + G, impart high absorption as well as non-adherent properties. The finish I + G is superior in imparting non-adherence to RV dressing, both in dry and moist conditions. This means that irrigation with water, saline or sodium citrate solution before removing the dressing from a wound is not needed. CONCLUSION: A number of novel knitted and crochet structures with enhanced absorbency have been designed for wound management using standard bleached fibres. Novel non-adherent finishes for the developed structures have been formulated for the developed dressings, and offer an alternative to existing non-adherent dressings.