Magnetic resonance imaging investigations in patients with metallic dental prosthesis: "The associated dilemma for medical fraternity and the dentist's role".

Background: Interdisciplinary referrals for dental examination in hospital setups are common before radiotherapy, kidney transplants, or magnetic resonance imaging (MRI). The patients who walk in could be random patients with metallic or porcelain-fused-to-metal prostheses done elsewhere but might require an opinion before the MRI. This leaves quite a responsibility on the consulting dentist to green signal the procedure. There is a lack of evidence in the literature, to confirm the absence of any untoward consequence during such MRI, which might leave the dentist in dilemma. Dental materials' magnetic behavior raises concern regarding whether they are 100% nonferromagnetic; furthermore, the examining dentist might be unaware of the metal used (Co-Cr, Ni-Cr, or trace elements). Clinicians may also come across full-mouth rehabilitated patients with multiple crown-bridge prostheses or metallic superstructure for implant prostheses. Research in the area leaves many unanswered questions because most studies have evaluated artifacts during MRI and are in vitro. Titanium is considered to be safe due to its paramagnetic behavior, whereas the literature does not rule out the probability of dislodgment of other porcelain fused to metal (PFM) prostheses. Due to less reported literature there exists dilemma to ascertain MRI in these patients. An online Google Search, PubMed, and gray literature portray the ambiguity associated with metal and PFM crowns and their magnetic behavior during MRI. Most studies were associated with the artifacts caused during MRI and methods of reducing them under in vitro situations. The concern for dislodgment has also been expressed in a few reports. Technique: Certain steps of a pre-MRI checkup and an innovative technique have been discussed to assure patient safety during the MRI. Conclusion: The technique explained is inexpensive and a quick aid that can be executed before the investigation. Clinical and Research Implications: There is a need to study and understand the magnetic behavior of Co-Cr and Ni-Cr crowns in the presence of various MRI strengths.

Phenomenology, disability and sexual functioning in female Dhat syndrome: a study of tertiary care gynaecology outpatients.

Background: Dhat syndrome, a clinical condition related to semen loss in urine often found among males in India, has rarely been described as a separate clinical condition in females. Women with the syndrome complain of passing vaginal discharge and can be excessively concerned and preoccupied with it, often attributing various physical symptoms to the loss of vaginal fluids. Aims: This study aimed to assess the sociodemographic and clinical profiles of female patients with Dhat syndrome and their perceived stress, disability and sexual functioning. Methods: Sociodemographic details of 70 females with non-pathological vaginal discharge were evaluated with a semistructured sociodemographic assessment. The phenomenology of the vaginal discharge was assessed with the Scale for Assessment of Female Dhat Syndrome Questionnaire. Anxiety and depressive symptoms were measured with the Hospital Anxiety and Depression Scale. Perceived stress in the past month and disability caused by the illness were assessed with the Perceived Stress Scale and the World Health Organization Disability Assessment Scale. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Level 2 Somatic Symptoms Scale was administered to rate the severity of somatic symptoms, and sexual functioning was evaluated using the Female Sexual Function Index (FSFI) scale for women who had had sexual intercourse in the past month. Results: The mean age of onset vaginal discharge was 23.0 (6.6) years. Biological factors, such as urinary tract infection, were the commonly attributed cause of the loss of vaginal fluids. Psychiatric comorbidity and perceived moderate stress in the past month were found in 38.6% and 68.6% of female patients with Dhat syndrome, respectively. Disability scores tended to be low. Among the females having had sexual intercourse in the past month, 48.3% had FSFI scores indicative of a female sexual disorder. Conclusions: The clinical presentation of women with non-pathological vaginal discharge is similar to that of males with Dhat syndrome. It requires comprehensive assessment and management that targets the biological, social and psychological factors and cultural issues.

Estimating Ni, Cr, Co, and Mo release from 3 dental casting alloys in saliva and blood at 6 and 12 months by using inductively coupled plasma mass spectroscopy.

STATEMENT OF PROBLEM: The leaching of elements from long-term definitive prostheses, with saliva acting as an electrolyte, poses a biological concern. The approximate concentration in the biological samples that are considered clinically toxic ranges from 1 to 5000 nmol/L for Cr and Co, 1 to 200 nmol/L for Ni, and 1 to 20 nmol/L for Mo. While in vitro studies are available regarding the leaching of elements in artificial saliva, solutions containing protein, solutions of different pH, and different culture media, the in vivo effects of leaching in the biological sample with increasing time are unknown. PURPOSE: The purpose of this clinical study was to quantify the Ni, Co, Cr, and Mo metals in saliva and blood before and after restoration with prostheses made from 3 different brands of dental casting alloy at 6 and 12 months. MATERIAL AND METHODS: Three popular brands of Ni-Cr alloy with different compositions were evaluated. A total of 150 participants requiring a definitive prosthesis were enrolled and divided into 3 groups (n=50). Heavy metal levels from saliva and blood were measured by using the inductively coupled plasma mass spectroscopy method before cementation of the prosthesis and after 6 and 12 months. RESULTS: The presence of Ni in saliva was in the range of 10.34 to 12.12 µg/L, Cr was 1.04 to 1.22 µg/L, and Mo was 1.04 to 1.08 µg/L over a period of 6 and 12 months after cementation of the metal prosthesis. The presence of Ni in blood was in the range of 6.35 to 14.45 µg/L and that of Cr was 9.09 to 16.16 µg/L over a period of 6 and 12 months after cementation. Co levels were not detected from any brands in saliva or blood, and Mo was detected only in the saliva samples. CONCLUSIONS: Increased levels of Ni and Cr in saliva and blood from all 3 brands of base metal alloy at 6 and 12 months were observed at higher than threshold values.

Choosing the denture occlusion - A Systematic review.

AIM: The aim of the study is to acquire evidence for the choice of occlusion with anatomic/modified anatomic teeth in complete denture prosthesis. SETTINGS AND DESIGN: Systematic review following PRISMA guidelines. MATERIALS AND METHODS: The study reviewed original articles on various occlusal schemes bilateral balance occlusion (BBO), lingual occlusion (LO), Canine guided occlusion (CG), posterior group function occlusion (PGFO) have been applied to the complete dentures and were analyzed for the objective or subjective or both evaluations. The data were collected in standard format with the needed information such as year of publication, type of study, occlusal schemes compared, test methodology used, sample size for experiment and control, assessment of retention, stability, and other factors which determine the quality of life and period of follow-up. The risk of bias was calculated using tools RoB2.0 and robvis. At all stages, the inclusion and exclusion of studies were discussed among the reviewers. STATISTICAL ANALYSIS USED: Due to the heterogeneity in the data of the included studies no statistical analysis was used. RESULTS: Of the 1896 articles screened only 17 studies were included in the systematic review. These were discussed amongst the reviewers regarding the various occlusion schemes used. The subjective and objective criteria used in the studies was tabulated separately. They were then analyzed for the risk of bias using the robvis 2 tool. CONCLUSION: No scheme is more superior to the other with the anatomic tooth forms. The use of alternative unbalanced schemes produces a similar satisfactory clinical outcome. The ridge classification also has a significant role to play in the preference for an occlusal scheme.