Genome-wide expression and response to exposure-based psychological therapy for anxiety disorders.

Exposure-based psychological treatments for anxiety have high efficacy. However, a substantial proportion of patients do not respond to therapy. Research examining the potential biological underpinnings of therapy response is still in its infancy, and most studies have focussed on candidate genes. To our knowledge, this study represents the first investigation of genome-wide expression profiles with respect to treatment outcome. Participants (n=102) with panic disorder or specific phobia received exposure-based cognitive behavioural therapy. Treatment outcome was defined as percentage reduction from baseline in clinician-rated severity of their primary anxiety diagnosis at post treatment and 6 month follow-up. Gene expression was determined from whole blood samples at three time points using the Illumina HT-12v4 BeadChip microarray. Linear regression models tested the association between treatment outcome and changes in gene expression from pre-treatment to post treatment, and pre-treatment to follow-up. Network analysis was conducted using weighted gene co-expression network analysis, and change in the detected modules from pre-treatment to post treatment and follow-up was tested for association with treatment outcome. No changes in gene expression were significantly associated with treatment outcomes when correcting for multiple testing (q<0.05), although a small number of genes showed a suggestive association with treatment outcome (q<0.5, n=20). Network analysis showed no association between treatment outcome and change in gene expression for any module. We report suggestive evidence for the role of a small number of genes in treatment outcome. Although preliminary, these findings contribute to a growing body of research suggesting that response to psychological therapies may be associated with changes at a biological level.

Influence of platform switching on bone-level alterations: a three-year randomized clinical trial.

The concept of platform switching has been introduced to implant dentistry based on clinical observations of reduced peri-implant crestal bone loss. However, published data are controversial, and most studies are limited to 12 months. The aim of the present randomized clinical trial was to test the hypothesis that platform switching has a positive impact on crestal bone-level changes after 3 years. Two implants with a diameter of 4 mm were inserted crestally in the posterior mandible of 25 patients. The intraindividual allocation of platform switching (3.3-mm platform) and the standard implant (4-mm platform) was randomized. After 3 months of submerged healing, single-tooth crowns were cemented. Patients were followed up at short intervals for monitoring of healing and oral hygiene. Statistical analysis for the influence of time and platform type on bone levels employed the Brunner-Langer model. At 3 years, the mean radiographic peri-implant bone loss was 0.69 ± 0.43 mm (platform switching) and 0.74 ± 0.57 mm (standard platform). The mean intraindividual difference was 0.05 ± 0.58 mm (95% confidence interval: -0.19, 0.29). Crestal bone-level alteration depended on time (p < .001) but not on platform type (p = .363). The present randomized clinical trial could not confirm the hypothesis of a reduced peri-implant crestal bone loss, when implants had been restored according to the concept of platform switching.

Dental anxiety in a representative sample of residents of a large German city.

In a demographic survey, 300 residents of a German city were questioned to determine the prevalence of dental anxiety. The correlation between the amount of dental anxiety and the age, sex, and education of the subjects was examined and the reasons for avoiding dentist's appointments, the duration of this avoidance, and what the subjects desire from future dental treatment. The Hierarchical Anxiety Questionnaire (HAQ) was used to measure the amount of dental anxiety. The average level of anxiety was 28.8+/-10.1 according to the HAQ. Young people were more afraid than older people (p=0.007), and women were more anxious than men (p=0.004). Of the women, 72% go to the dentist regularly, but only 60% of the men do (p=0.020). A painful experience while receiving dental treatment was given by 67% as the main reason for their dental anxiety, followed by a fear of needles (35%). The people wished for the most accurate information available about the dental treatment they receive (69%), followed by a compassionate dentist (62%), and treatment that is free of pain (62%). Of the people, 11% [95% CI: (7.5%; 14.5%)] suffer from dental phobia. All dental phobics were able to state the cause of their fear and more urgently wished for help from the dentist in overcoming their anxiety than the non-phobics (p=0.030). To satisfy the needs of the phobic patients, it appears necessary to screen the phobics out of the group of all patients and then offer them adequate therapy, or refer these patients to specialised treatment centres.

Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office.

The goal of this study was to investigate the impact of the essential oils of orange and lavender on anxiety, mood, alertness and calmness in dental patients. Two hundred patients between the ages of 18 and 77 years (half women, half men) were assigned to one of four independent groups. While waiting for dental procedures patients were either stimulated with ambient odor of orange or ambient odor of lavender. These conditions were compared to a music condition and a control condition (no odor, no music). Anxiety, mood, alertness and calmness were assessed while patients waited for dental treatment. Statistical analyses revealed that compared to control condition both ambient odors of orange and lavender reduced anxiety and improved mood in patients waiting for dental treatment. These findings support the previous opinion that odors are capable of altering emotional states and may indicate that the use of odors is helpful in reducing anxiety in dental patients.

[Experimental algesimetric study of the hypoalgesic effect of body acupuncture]. / Experimentelle algesimetrische Untersuchung zum hypalgetischen Effekt der Körperakupunktur.

AIMS: The aim of the present study was to investigate whether body acupuncture is suitable to increase the pre-pain sensitivity threshold (PPST). METHODS: For this purpose, the PPST was algesimetrically determined after pulpal electric stimulation (baseline) in 24 patients with healthy frontal teeth. RESULTS AND DISCUSSION: After acupuncture at specific (test group) and unspecific sites (control group, placebo acupuncture), the shift of the PPST was registered. After stimulation of specific acupuncture sites, a mean increase of 110% of the PPST could be obtained. Stimulation at unspecific sites showed only an increase of the PPST of 30%. To which extent this pain reduction is due to a physiological effect on pain reception, or physical irritation, or suggestion could not be verified in this study. Also, the endorphin theory discussed in connection with acupuncture could neither be proved nor disproved. Further controlled clinical studies have to be carried out to prove under clinical conditions the positive results of this experimental algesimetric study.

Implant-supported denture in a patient with Huntington's disease: interdisciplinary aspects.

Patients with extrapyramidal diseases often cannot maintain independent, efficient oral hygiene due to restricted motor ability of the upper extremities and lack of coordination. The hermetic closure of the mouth and lips, and the associated ability to keep liquid and toothpaste in the mouth, can become so weak that effective oral hygiene cannot be maintained. Over a period of many years, this illness leads to loss of teeth and the need for complete prosthodontic care. Dyskinesia and hyperkinesia of the tongue and the peri-oral musculature, combined with xerostomia and pooling of saliva, make it impossible for the patient to wear a conventional complete denture, despite an anatomically-adequate bearing area. In such cases, an implant-supported prosthesis is a better therapeutic measure, although some aspects of oral hygiene must initially be disregarded. Two ITI implants were inserted into the anterior mandibular region of a patient with Huntington's chorea, because a complete denture could not be retained on the alveolar ridge, despite adequate vestibule depth, due to tongue dyskinesia. A bar joint was used to anchor this mucosal-borne denture. This implant-supported complete denture led to a clear improvement in the patient's chewing function when observed over a period of a year.

Fear reduction in patients with dental treatment phobia.

In a clinical trial, we examined short- and medium-term reduction of dental fear in patients with dental phobia. Ninety-one patients selected one of two treatments or no intervention before oral surgery (control group). One group comprised a one-session psychological treatment and included 25 patients. The second group chose oral selected midazolam and included 30 patients. Thirty-six patients chose the control group. In total, 50 patients completed the study (10 controls, 20 in the midazolam group, an d 20 in the treated group). The degree of fear was assessed by the Corah Dental Anxiety Scale. Before the operation, both interventions caused the degree of fear to fall significantly compared with the control group. Two months later, the midazolam group showed a return to baseline fear, whereas the psychologically treated group showed further improvement. Medium-term results after one year showed that compliance and reduction of fear remained only in the psychologically treated group.

Comparison between one-session psychological treatment and benzodiazepine in dental phobia.

To compare the effects of a single session of psychological treatment and acute administration of benzodiazepine, 50 dental phobic patients were allocated either to psychological treatment, benzodiazepine, or no treatment for anxiety. Psychological treatment consisted of stress management training and imaginal exposure to phobic stimuli with homework assignments. Benzodiazepine was administered 30 min before dental treatment. Both treatment conditions led to less anxiety during dental surgery than did the control condition. Phobic patients in the benzodiazepine condition showed a relapse after dental treatment, whereas those in the psychological treatment condition showed further improvement until the follow-up 2 months later. Of the latter group, 70% continued dental treatment; only 20% and 10% returned in the benzodiazepine and control conditions, respectively.

Imaging of fibrosis of the oral mucosa by 20 MHz sonography.

OBJECTIVES: To compare the ultrasonographic (US) appearances of the oral mucosa in health with patients with systemic sclerosis (SSc). METHODS: An innovative 20 MHz US scanner was used to examine the lips, cheeks and oral vestibule of ten healthy persons and ten patients with SSc. The clinical, US and histopathological features of one patient with a fibro-epithelial polyp of the buccal mucosa are reported in detail. RESULTS: Two patients with SSc displayed increased echogenicity due to fibrotic deposits. A similar echo pattern was seen in the case of the histopathologically verified fibro-epithelial polyp of the buccal mucosa. CONCLUSION: 20 MHz sonography may be suitable as a non-invasive tool for evaluation of fibrosis of the oral mucosa.

[Results of a comparative prospective randomized study of surgical removal of mandibular wisdom teeth with and without rubber drainage]. / Ergebnisse einer prospektiv randomisierten Studie zur operativen Entfernung unterer Weisheitszähne mit und ohne Gummi-Drainage im Vergleich.

This investigation compared the results of 2 types of wound closure - primary closure technique with and without Penrose drains (Naturallatex) - after mandibular third Molar removal. In both the test group (n = 27) and control group (n = 25), the molar were removed using a buccal mucoperiosteal flap. The test group received a drain partially submerged into the socket to secure more drainage of woundsecrete. Examination were performed 1 day, 3 days and 7 days after surgery, and swelling, trismus, pain and analgetic consommation were recorded. Analysis of Variance indicated that there was significant difference between the 2 methods. The drain method appears to minimize postoperative edema, trismus, pain and analgetic consommation, and thus contributes to enhanced patient comfort.